Provider Demographics
NPI:1710109327
Name:HEARING PROFESSIONALS OF WALDORF, INC
Entity Type:Organization
Organization Name:HEARING PROFESSIONALS OF WALDORF, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:301-932-4237
Mailing Address - Street 1:3460 OLD WASHINGTON RD
Mailing Address - Street 2:STE 203
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3240
Mailing Address - Country:US
Mailing Address - Phone:301-932-4237
Mailing Address - Fax:301-932-9027
Practice Address - Street 1:3460 OLD WASHINGTON RD
Practice Address - Street 2:STE 203
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3240
Practice Address - Country:US
Practice Address - Phone:301-932-4237
Practice Address - Fax:301-932-9027
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARING PROFESSIONALS OF WALDORF, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-03
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD780L832DMedicare PIN