Healthcare Provider Details

I. General information

NPI: 1780204032
Provider Name (Legal Business Name): BLUE CRAB HEARING CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25455 ADAMS LANDING RD
DENTON MD
21629-3336
US

IV. Provider business mailing address

25455 ADAMS LANDING RD
DENTON MD
21629-3336
US

V. Phone/Fax

Practice location:
  • Phone: 443-499-3277
  • Fax: 866-282-2830
Mailing address:
  • Phone: 443-499-3277
  • Fax: 866-282-2830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: DR. CALEB MCNIECE
Title or Position: OWNER
Credential: AUD
Phone: 443-499-3277