Healthcare Provider Details

I. General information

NPI: 1538485727
Provider Name (Legal Business Name): MOBILE MEDICAL AUDIOLOGY MA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 HIGH ST STE 23
MEDFORD MA
02155-3850
US

IV. Provider business mailing address

92 HIGH ST STE 23
MEDFORD MA
02155-3850
US

V. Phone/Fax

Practice location:
  • Phone: 617-947-0615
  • Fax: 781-723-4691
Mailing address:
  • Phone: 617-947-0615
  • Fax: 781-723-4691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: LOUIS ANTHONY FEMINO
Title or Position: OWNER
Credential: CCC-A
Phone: 617-947-0615