Provider Demographics
NPI:1770776817
Name:WILMINGTON HEARING SPECIALISTS PA
Entity type:Organization
Organization Name:WILMINGTON HEARING SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:910-791-4755
Mailing Address - Street 1:3909 WRIGHTSVILLE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6250
Mailing Address - Country:US
Mailing Address - Phone:910-791-4755
Mailing Address - Fax:910-799-0476
Practice Address - Street 1:3909 WRIGHTSVILLE AVE STE 110
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6250
Practice Address - Country:US
Practice Address - Phone:910-791-4755
Practice Address - Fax:910-799-0476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1790231HA2400X, 231HA2500X, 237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Single Specialty
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology SupplierGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2348115Medicare PIN