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General NPI Number Information
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NPI Number | 1073287553
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Entity Type | Organization
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Legal Business Name | A 2ND EAR
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Dates
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Enumeration Date | 08/06/2021
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Last Update Date | 08/26/2021
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Provider Practice Location Address
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Address Line | 9711 WASHINGTONIAN BLVD STE 550
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City | GAITHERSBURG
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State | MD
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Zip | 20878-5789
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Country | US
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Telephone | 240-579-0756
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Fax |
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Provider Business Mailing Address
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Address Line | 15500 HALLMAN GROVE CT
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City | NORTH POTOMAC
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State | MD
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Zip | 20878-3474
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Country | US
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Telephone | 301-379-4151
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Fax |
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Authorized Official
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Title or Position | OWNER & AUDIOLOGIST
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Name | DR. ANDREA ELENI LIACOURAS
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Credential | AU.D., CCC-A
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Telephone | 240-579-0756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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