Healthcare Provider Details

I. General information

NPI: 1851665905
Provider Name (Legal Business Name): BETHESDA AUDIOLOGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8218 WISCONSIN AVE SUITE 106
BETHESDA MD
20814-3107
US

IV. Provider business mailing address

8218 WISCONSIN AVE SUITE 106
BETHESDA MD
20814-3107
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-1933
  • Fax: 301-656-0881
Mailing address:
  • Phone: 301-656-1933
  • Fax: 301-656-0881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number00486
License Number StateMD

VIII. Authorized Official

Name: DR. AURION LOUIDR DWYER
Title or Position: DOCTOR OF AUDIOLOGY
Credential: AU.D.
Phone: 301-656-1933