Healthcare Provider Details

I. General information

NPI: 1487849493
Provider Name (Legal Business Name): AUDIOLOGY FIRST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8850 STANFORD BLVD STE 1700
COLUMBIA MD
21045-4765
US

IV. Provider business mailing address

8850 STANFORD BLVD STE 1700
COLUMBIA MD
21045-4765
US

V. Phone/Fax

Practice location:
  • Phone: 410-964-9511
  • Fax: 410-964-9513
Mailing address:
  • Phone: 410-964-9511
  • Fax: 410-964-9513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number562
License Number StateMD

VIII. Authorized Official

Name: DIANA J WAGNER
Title or Position: OWNER/AUDIOLOGIST
Credential:
Phone: 410-964-9511