Provider Demographics
NPI:1619128436
Name:ANNAPOLIS AUDIOLOGY HEARING CENTER, INC.
Entity Type:Organization
Organization Name:ANNAPOLIS AUDIOLOGY HEARING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HELLYER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:443-837-6052
Mailing Address - Street 1:116 DEFENSE HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7027
Mailing Address - Country:US
Mailing Address - Phone:443-837-6792
Mailing Address - Fax:
Practice Address - Street 1:116 DEFENSE HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7027
Practice Address - Country:US
Practice Address - Phone:443-837-6792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01075261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
1972595791OtherMEDICARE NPI
1972595791OtherMEDICARE NPI