Healthcare Provider Details

I. General information

NPI: 1063210334
Provider Name (Legal Business Name): AUDIOLOGY DISTRIBUTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 OLD WASHINGTON RD STE 203
WALDORF MD
20602-3242
US

IV. Provider business mailing address

PO BOX 200132
DALLAS TX
75320-0132
US

V. Phone/Fax

Practice location:
  • Phone: 301-932-4237
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MORGAN KLEIN
Title or Position: DIRECTOR OF INSURANCE CONTRACTING
Credential:
Phone: 561-678-3394