=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437745288
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICK M HARTIGAN HIS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2020
-----------------------------------------------------
Last Update Date | 12/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 624 INDEPENDENCE BLVD STE 105
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23462-2211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-687-6643
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 624 INDEPENDENCE BLVD STE 105
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23462-2211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-687-6643
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 2101002392
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------