Healthcare Provider Details

I. General information

NPI: 1891907457
Provider Name (Legal Business Name): LEDNUM'S JEWELERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 POPLAR ST LEDNUM BUILDING
CAMBRIDGE MD
21613-1833
US

IV. Provider business mailing address

525 POPLAR ST LEDNUM BUILDING
CAMBRIDGE MD
21613-1833
US

V. Phone/Fax

Practice location:
  • Phone: 410-228-1676
  • Fax: 410-228-7464
Mailing address:
  • Phone: 410-228-1676
  • Fax: 410-228-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201 001234
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2101 001488
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number01059
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2101 000030
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number02-0000132
License Number StateDE
# 6
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number01025
License Number StateMD

VIII. Authorized Official

Name: MR. CHARLES NOBLE LEDNUM III
Title or Position: AUDIOLOGIST/SECRETARY
Credential: M.A.
Phone: 443-521-0576