Healthcare Provider Details

I. General information

NPI: 1184794935
Provider Name (Legal Business Name): MICHELE BASSETT AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 MERCANTILE LANE
LANDOVER MD
20774-5374
US

IV. Provider business mailing address

2101 E JEFFERSON STREET 3 WEST ATTENTION SANJAY MATHUR KAISER PERMANENTE DATA M
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 301-618-5500
  • Fax: 301-618-5716
Mailing address:
  • Phone: 301-816-7446
  • Fax: 301-816-7170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number00327
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: