Provider Demographics
NPI:1255685483
Name:PROFESSIONAL AUDIOLOGY PC
Entity Type:Organization
Organization Name:PROFESSIONAL AUDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:REGAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:603-436-8668
Mailing Address - Street 1:330 BORTHWICK AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4174
Mailing Address - Country:US
Mailing Address - Phone:603-436-8668
Mailing Address - Fax:603-436-4499
Practice Address - Street 1:330 BORTHWICK AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4174
Practice Address - Country:US
Practice Address - Phone:603-436-8668
Practice Address - Fax:603-436-4499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80648803Medicaid
NHNH8803Medicare PIN