=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518240407
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FREDERICK HEARING CENT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2011
-----------------------------------------------------
Last Update Date | 12/02/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 DELAWARE RD
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21701-4618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-663-0553
-----------------------------------------------------
Fax | 301-663-4189
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 310 DELAWARE RD
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21701-4618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-663-0553
-----------------------------------------------------
Fax | 301-663-4189
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LORI BARR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-663-0553
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------