Healthcare Provider Details

I. General information

NPI: 1770776817
Provider Name (Legal Business Name): WILMINGTON HEARING SPECIALISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 WRIGHTSVILLE AVE STE 110
WILMINGTON NC
28403-6250
US

IV. Provider business mailing address

3909 WRIGHTSVILLE AVE STE 110
WILMINGTON NC
28403-6250
US

V. Phone/Fax

Practice location:
  • Phone: 910-791-4755
  • Fax: 910-799-0476
Mailing address:
  • Phone: 910-791-4755
  • Fax: 910-799-0476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1790
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number1790
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number1790
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1790
License Number StateNC

VIII. Authorized Official

Name: DR. MARY MADDOCK
Title or Position: OWNER
Credential: AUD
Phone: 910-791-4755