Healthcare Provider Details

I. General information

NPI: 1255663084
Provider Name (Legal Business Name): CHESAPEAKE AUDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25480 POINT LOOKOUT RD
LEONARDTOWN MD
20650-3801
US

IV. Provider business mailing address

25480 POINT LOOKOUT RD
LEONARDTOWN MD
20650-3801
US

V. Phone/Fax

Practice location:
  • Phone: 301-997-0909
  • Fax: 301-997-0919
Mailing address:
  • Phone: 240-434-4040
  • Fax: 240-434-4039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number01069
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number01069
License Number StateMD

VIII. Authorized Official

Name: DR. LEIGH MCCARTHY
Title or Position: AUDIOLOGIST
Credential: AUD
Phone: 240-434-4040