Commonwealth Ear, Nose & Throat Associates, LLC

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

Legal business name

COMMONWEALTH EAR, NOSE & THROAT ASSOCIATES, LLC

Practice address

2280 Opitz Blvd
Suite 340
Woodbridge, VA 22191

Phone

(703) 878-0777

Fax

(703) 583-1777

NPI assigned

Jul 8, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Carol J Ekins

Title

Office Manager

Phone

(703) 878-0777

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Stephen M Bane MD PLC Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241568000000",
    "number": "1003849720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2280 OPITZ BLVD",
            "address_2": "SUITE 340",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "22191",
            "telephone_number": "703-878-0777",
            "fax_number": "703-583-1777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2280 OPITZ BLVD",
            "address_2": "SUITE 340",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "22191",
            "telephone_number": "703-878-0777",
            "fax_number": "703-583-1777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONWEALTH EAR, NOSE & THROAT ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2009-05-06",
        "status": "A",
        "authorized_official_last_name": "EKINS",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "703-878-0777",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC5029",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6500226",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stephen M Bane MD PLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Otolaryngology Physician in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Otolaryngology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.