Healthcare Provider Details

I. General information

NPI: 1811323041
Provider Name (Legal Business Name): MARIA TAFFONI HETLINGER AU. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ARBOR LAKE DR STE 120
COLUMBIA SC
29223-4516
US

IV. Provider business mailing address

351 TAVISTOCK DR
MEDFORD NJ
08055-9259
US

V. Phone/Fax

Practice location:
  • Phone: 803-457-8120
  • Fax:
Mailing address:
  • Phone: 609-346-5391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00063200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number25MG00098800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT005811
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: