Healthcare Provider Details

I. General information

NPI: 1710146014
Provider Name (Legal Business Name): AUDIOLOGY & HEARING AID SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

985 FOREST AVE
PORTLAND ME
04103-3303
US

IV. Provider business mailing address

985 FOREST AVE
PORTLAND ME
04103-3303
US

V. Phone/Fax

Practice location:
  • Phone: 207-797-8738
  • Fax: 207-797-8650
Mailing address:
  • Phone: 207-797-8738
  • Fax: 207-797-8650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAP1825
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberDL20000383
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAP25
License Number StateME

VIII. Authorized Official

Name: DR. JAMES ROGER FAGAN
Title or Position: OWNER
Credential: AU.D.
Phone: 207-797-8738