Healthcare Provider Details

I. General information

NPI: 1063034759
Provider Name (Legal Business Name): ADVANCED MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 CAMPBELL BLVD STE 215
WHITE MARSH MD
21162-5504
US

IV. Provider business mailing address

6801 OAK HALL LN UNIT 293
COLUMBIA MD
21045-7512
US

V. Phone/Fax

Practice location:
  • Phone: 877-361-0100
  • Fax: 443-283-8426
Mailing address:
  • Phone: 205-255-4911
  • Fax: 866-236-7933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SANJAY SRIVASTAVA
Title or Position: PRESIDENT
Credential:
Phone: 410-205-4911