Provider Demographics
NPI:1346546942
Name:UPDEGROVE, ROBERTA (MA)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:UPDEGROVE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 AGORA DR
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-6859
Mailing Address - Country:US
Mailing Address - Phone:877-255-3277
Mailing Address - Fax:866-236-7933
Practice Address - Street 1:1201 AGORA DR
Practice Address - Street 2:SUITE 2C
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-6859
Practice Address - Country:US
Practice Address - Phone:877-255-3277
Practice Address - Fax:866-236-7933
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1217231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist