Healthcare Provider Details

I. General information

NPI: 1174128631
Provider Name (Legal Business Name): MIA RAY HAD, PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11120 NEW HAMPSHIRE AVE STE 504
SILVER SPRING MD
20904-2618
US

IV. Provider business mailing address

11120 NEW HAMPSHIRE AVE STE 504
SILVER SPRING MD
20904-2618
US

V. Phone/Fax

Practice location:
  • Phone: 301-593-3200
  • Fax:
Mailing address:
  • Phone: 301-593-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number02859
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: