1306172275 NPI number — ANDREA ELENI LIACOURAS AU.D., CCC-A

NPI Number: 1306172275
Health Care Provider/Practitioner: ANDREA ELENI LIACOURAS AU.D., CCC-A

NPI Number : 1306172275 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306172275",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LIACOURAS",
    "FirstName": "ANDREA",
    "MiddleName": "ELENI",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "AU.D., CCC-A",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "15500 HALLMAN GROVE CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NORTH POTOMAC",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "20878-3474",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "301-379-4151",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "9711 WASHINGTONIAN BLVD STE 550",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GAITHERSBURG",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "20878-5789",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "240-579-0756",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/27/2009",
    "LastUpdateDate": "06/03/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "231H00000X",
          "TaxonomyName": "Audiologist",
          "LicenseNumber": "AT006731",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "231H00000X",
          "TaxonomyName": "Audiologist",
          "LicenseNumber": "2201001824",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "231H00000X",
          "TaxonomyName": "Audiologist",
          "LicenseNumber": "01158",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}