Provider Demographics
NPI:1073287553
Name:A 2ND EAR
Entity Type:Organization
Organization Name:A 2ND EAR
Other - Org Name:A 2ND EAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER & AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:ELENI
Authorized Official - Last Name:LIACOURAS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD, CCC-A
Authorized Official - Phone:240-579-0756
Mailing Address - Street 1:15500 HALLMAN GROVE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3474
Mailing Address - Country:US
Mailing Address - Phone:301-379-4151
Mailing Address - Fax:
Practice Address - Street 1:9711 WASHINGTONIAN BLVD STE 550
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5789
Practice Address - Country:US
Practice Address - Phone:240-579-0756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-06
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty