Provider Demographics
NPI:1053442459
Name:AUDIOLOGY UNLIMITED, LLC
Entity Type:Organization
Organization Name:AUDIOLOGY UNLIMITED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL/DOCTOR OF AUDIOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MELLOTT
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:301-780-6770
Mailing Address - Street 1:15209 MARLBORO PIKE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3151
Mailing Address - Country:US
Mailing Address - Phone:301-780-6770
Mailing Address - Fax:301-780-6772
Practice Address - Street 1:15209 MARLBORO PIKE
Practice Address - Street 2:SUITE 208
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3151
Practice Address - Country:US
Practice Address - Phone:301-780-6770
Practice Address - Fax:301-780-6772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG01654Medicare ID - Type UnspecifiedGROUP #