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General NPI Number Information
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NPI Number | 1326770553
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Entity Type | Individual
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Provider Name | JARETH ISAIAH BIDWELL AUD
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Gender | Male
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 2331 YORK RD STE 102
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City | LUTHERVILLE TIMONIUM
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State | MD
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Zip | 21093-2246
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Country | US
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Telephone | 410-816-9660
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Fax | 410-397-5209
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Provider Business Mailing Address
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Address Line | 4424 WALNUT RD
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City | HALETHORPE
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State | MD
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Zip | 21227-3504
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Country | US
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Telephone | 915-471-1547
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 01606
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License Number State | MD
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