Provider Demographics
NPI:1114988011
Name:WISE, VIRGINIA LEA (AUD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:LEA
Last Name:WISE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 DUAL HWY STE 303
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6648
Mailing Address - Country:US
Mailing Address - Phone:301-739-0400
Mailing Address - Fax:301-739-0402
Practice Address - Street 1:1800 DUAL HWY STE 303
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740
Practice Address - Country:US
Practice Address - Phone:301-739-0400
Practice Address - Fax:301-739-0402
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001817231H00000X
MD1094231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist