MEDICARE: DR. MULLIN'S HEARING CENTER

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	237700000X	Hearing Instrument Specialist	2352	MD

General Provider Information

NPI Number	:	1861769622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. MULLIN'S HEARING CENTER

Provider Business Mailing Address
First Line	:	3010 CRAIN HWY STE 302
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20601-2838
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3010 CRAIN HWY STE 302
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20601-2838
Country	:	US
Telephone Number	:	301-638-3592
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW C DIAS JR.
Credential	:	BC-HIS
Telephone Number	:	301-638-3592

Provider Enumeration Date	:	11/22/2011
Last Update Date	:	11/22/2011

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