Provider Demographics
NPI:1336129279
Name:MEDIA HEARING AID CENTER, P.C.
Entity Type:Organization
Organization Name:MEDIA HEARING AID CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, HIS
Authorized Official - Phone:610-565-0906
Mailing Address - Street 1:295 N PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3505
Mailing Address - Country:US
Mailing Address - Phone:610-565-0906
Mailing Address - Fax:
Practice Address - Street 1:295 N PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3505
Practice Address - Country:US
Practice Address - Phone:610-565-0906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAFO2216237700000X
PAF03263237700000X
PAF02216332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332S00000XSuppliersHearing Aid Equipment
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty