Healthcare Provider Details

I. General information

NPI: 1275690786
Provider Name (Legal Business Name): MARTHA A WOOTEN ACA, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7544 HOLABIRD AVE
BALTIMORE MD
21222-2104
US

IV. Provider business mailing address

7544 HOLABIRD AVE
BALTIMORE MD
21222-2104
US

V. Phone/Fax

Practice location:
  • Phone: 410-284-2889
  • Fax:
Mailing address:
  • Phone: 410-284-2889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number01883
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: