Provider Demographics
NPI:1629177175
Name:HEARING SPECIALTY GROUP, LTD.
Entity Type:Organization
Organization Name:HEARING SPECIALTY GROUP, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, FAAA, CCC-A
Authorized Official - Phone:410-590-9462
Mailing Address - Street 1:8028 RITCHIE HWY
Mailing Address - Street 2:STE 311
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1360
Mailing Address - Country:US
Mailing Address - Phone:410-590-9462
Mailing Address - Fax:410-590-9464
Practice Address - Street 1:8028 RITCHIE HWY
Practice Address - Street 2:STE 311
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-1360
Practice Address - Country:US
Practice Address - Phone:410-590-9462
Practice Address - Fax:410-590-9464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00658231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8632OtherCAREFIRST DC GROUP#
MD86RVHEOtherCAREFIRST MARYLAND GROUP #
MD413159200Medicaid
MD86RVHEOtherCAREFIRST MARYLAND GROUP #