Healthcare Provider Details

I. General information

NPI: 1336363225
Provider Name (Legal Business Name): MASS AUDIOLOGY & HEARING SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 WESTGATE DRIVE
BROCKTON MA
02301
US

IV. Provider business mailing address

165 WESTGATE DRIVE
BROCKTON MA
02301
US

V. Phone/Fax

Practice location:
  • Phone: 508-583-5800
  • Fax: 508-580-3152
Mailing address:
  • Phone: 508-583-5800
  • Fax: 508-580-3152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL FELLMAN
Title or Position: OWNER
Credential: AUD
Phone: 508-583-5800