MEDICARE: ATLANTIC AUDIOLOGY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237600000X	Audiologist-Hearing Aid Fitter	01075	MD

General Provider Information

NPI Number	:	1316088909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC AUDIOLOGY, LLC

Provider Business Mailing Address
First Line	:	224 OLIVER HEIGHTS RD
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-5073
Country	:	US
Telephone Number	:	310-742-7779
Fax Number	:

Provider Business Practice Location Address
First Line	:	19110 MONTGOMERY VILLAGE AVE
Second Line	:	SUITE 120
City	:	GAITHERSBURG
State	:	MD
Zip	:	20886-3702
Country	:	US
Telephone Number	:	301-977-6317
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JENIFER CUSHING
Credential	:	AU.D.
Telephone Number	:	301-742-7779

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	08/22/2020

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