Healthcare Provider Details

I. General information

NPI: 1326431719
Provider Name (Legal Business Name): KRISTY DAMERON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 GERMAN HILL RD
BALTIMORE MD
21222-1526
US

IV. Provider business mailing address

4225 LYNHURST RD
BALTIMORE MD
21222-3614
US

V. Phone/Fax

Practice location:
  • Phone: 410-299-2986
  • Fax:
Mailing address:
  • Phone: 410-299-2986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number02749
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: