Healthcare Provider Details

I. General information

NPI: 1174670053
Provider Name (Legal Business Name): TRICIA PASTORE-BARD AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 THOMAS JOHNSON DR SUITE A
FREDERICK MD
21702-4895
US

IV. Provider business mailing address

75 THOMAS JOHNSON DR SUITE A
FREDERICK MD
21702-4895
US

V. Phone/Fax

Practice location:
  • Phone: 301-695-3100
  • Fax: 310-695-7403
Mailing address:
  • Phone: 301-695-3100
  • Fax: 310-695-7403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number00992
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: