Healthcare Provider Details

I. General information

NPI: 1720767213
Provider Name (Legal Business Name): CHIARA ELIZABETH PONKO AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 08/13/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 LANDMARK DR. STE 119
GLEN BURNIE MD
21061
US

IV. Provider business mailing address

802 LANDMARK DR STE 119
GLEN BURNIE MD
21061
US

V. Phone/Fax

Practice location:
  • Phone: 410-760-8840
  • Fax: 410-367-2464
Mailing address:
  • Phone: 410-760-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number01666
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2201001921
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number01666
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: