Healthcare Provider Details

I. General information

NPI: 1508898107
Provider Name (Legal Business Name): WILMINGTON AUDIOLOGY SERVIVCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 PENNSYLVANIA AVE SUITE 1-C
WILMINGTON DE
19806-1392
US

IV. Provider business mailing address

2300 PENNSYLVANIA AVE SUITE 1-C
WILMINGTON DE
19806-1392
US

V. Phone/Fax

Practice location:
  • Phone: 302-654-1011
  • Fax:
Mailing address:
  • Phone: 302-654-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1989026866
License Number StateDE

VIII. Authorized Official

Name: DR. WILLIAM L. MEDFORD, JR.
Title or Position: OWNER
Credential: M.D.
Phone: 302-654-1011