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General NPI Number Information
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NPI Number | 1255685483
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL AUDIOLOGY PC
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Dates
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Enumeration Date | 11/09/2012
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Last Update Date | 04/16/2015
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Provider Practice Location Address
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Address Line | 330 BORTHWICK AVE SUITE 209
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City | PORTSMOUTH
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State | NH
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Zip | 03801-4174
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Country | US
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Telephone | 603-436-8668
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Fax | 603-436-4499
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Provider Business Mailing Address
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Address Line | 330 BORTHWICK AVE SUITE 209
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City | PORTSMOUTH
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State | NH
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Zip | 03801-4174
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Country | US
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Telephone | 603-436-8668
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Fax | 603-436-4499
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERICA L REGAN
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Credential | AUD
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Telephone | 603-436-8668
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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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