Provider Demographics
NPI:1710238175
Name:CRIASIA, JOHN E (BC, HIS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:CRIASIA
Suffix:
Gender:M
Credentials:BC, HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 DUAL HWY STE 303
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6648
Mailing Address - Country:US
Mailing Address - Phone:301-739-1047
Mailing Address - Fax:301-739-0402
Practice Address - Street 1:1800 DUAL HWY
Practice Address - Street 2:SUITE 303
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6602
Practice Address - Country:US
Practice Address - Phone:301-739-1047
Practice Address - Fax:301-739-0402
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02673237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist