Healthcare Provider Details

I. General information

NPI: 1851627806
Provider Name (Legal Business Name): MARC W. KUCZEWSKI LICENSED HEARING INS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MAIN ST SUITE 8
WESTBROOK ME
04092-4786
US

IV. Provider business mailing address

11 MAIN ST SUITE 8
WESTBROOK ME
04092-4786
US

V. Phone/Fax

Practice location:
  • Phone: 207-591-4136
  • Fax: 207-591-4138
Mailing address:
  • Phone: 207-591-4136
  • Fax: 207-591-4138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberDL374
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberH564
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: