NPIMap

Organization Active NPI

Northeast ENT

  • Facial Plastic Surgery Physician
  • N Dartmouth, MA
National Provider Identifier
1649345711
Registry record updated Jun 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Facial Plastic Surgery PhysicianTaxonomy code 207YS0123X
Legal business name
NORTHEAST ENT
Practice address
299 Faunce Corner Rd
N. Dartmouth, MA 02747
Phone
(508) 995-0700
Fax
(508) 995-3070
NPI assigned
Nov 22, 2006
Last updated
Jun 5, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2013

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

Authorized official

Name
Ms. Deborah Cornwall
Title
Practice Administrator
Phone
(508) 207-4462

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Facial Plastic Surgery Physician 207YS0123X Primary

Addresses

Primary practice location

299 Faunce Corner Rd
N. Dartmouth, MA 02747

Mailing address

299 Faunce Corner Rd
N. Dartmouth, MA 02747
Phone (508) 995-0700

Other identifiers 1

IdentifierTypeStateIssuer
9773312MedicaidMA

National Provider Directory

National Provider Directory

Locations

299 Faunce Corner Rd
Fl 2
North Dartmouth, MA 02747
Phone (508) 973-1550

112 Main St
Wareham, MA 02571
Phone (508) 291-1300

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370390400000",
    "number": "1649345711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "299 FAUNCE CORNER RD",
            "city": "N. DARTMOUTH",
            "state": "MA",
            "postal_code": "02747",
            "telephone_number": "508-995-0700",
            "fax_number": "508-995-3070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "299 FAUNCE CORNER RD",
            "city": "N. DARTMOUTH",
            "state": "MA",
            "postal_code": "02747",
            "telephone_number": "508-995-0700",
            "fax_number": "508-995-3070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST ENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2013-06-05",
        "status": "A",
        "authorized_official_last_name": "CORNWALL",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "508-207-4462",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9773312",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in N Dartmouth, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2013; 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.