Provider Demographics
NPI:1780340455
Name:HAGEDORN, ANTHONY DAVID
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DAVID
Last Name:HAGEDORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7678 QUARTERFIELD RD STE 202
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-7070
Mailing Address - Country:US
Mailing Address - Phone:410-553-9310
Mailing Address - Fax:410-553-0872
Practice Address - Street 1:32 VITAL WAY
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-3446
Practice Address - Country:US
Practice Address - Phone:410-553-9310
Practice Address - Fax:410-553-0872
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1549237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist