Healthcare Provider Details

I. General information

NPI: 1881655181
Provider Name (Legal Business Name): KAY L. WISE AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAY WISE MCMAHON

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 M STREET NW SUITE #620
WASHINGTON DC
20037-1565
US

IV. Provider business mailing address

2440 M STREET NW SUITE #620
WASHINGTON DC
20037-1565
US

V. Phone/Fax

Practice location:
  • Phone: 202-785-8300
  • Fax: 202-785-5040
Mailing address:
  • Phone: 202-785-8300
  • Fax: 202-785-5040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number00723
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: