Healthcare Provider Details

I. General information

NPI: 1255685483
Provider Name (Legal Business Name): PROFESSIONAL AUDIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BORTHWICK AVE SUITE 209
PORTSMOUTH NH
03801-4174
US

IV. Provider business mailing address

330 BORTHWICK AVE SUITE 209
PORTSMOUTH NH
03801-4174
US

V. Phone/Fax

Practice location:
  • Phone: 603-436-8668
  • Fax: 603-436-4499
Mailing address:
  • Phone: 603-436-8668
  • Fax: 603-436-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ERICA L REGAN
Title or Position: OWNER
Credential: AUD
Phone: 603-436-8668