Healthcare Provider Details

I. General information

NPI: 1104873942
Provider Name (Legal Business Name): CULPEPER HEARING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 ORANGE RD SUITE 105
CULPEPER VA
22701-4170
US

IV. Provider business mailing address

2002 ORANGE RD SUITE 105
CULPEPER VA
22701-4170
US

V. Phone/Fax

Practice location:
  • Phone: 540-829-9005
  • Fax:
Mailing address:
  • Phone: 540-829-9005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number2201000649
License Number StateVA

VIII. Authorized Official

Name: DR. DONNA MARIE MALLORY
Title or Position: OWNER
Credential: AUD
Phone: 540-829-9005