MEDICARE: MARK PRIEST

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

General Provider Information

NPI Number	:	1962049643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK PRIEST

Provider Business Mailing Address
First Line	:	2501 COTTONTAIL LN
Second Line	:
City	:	SOMERSET
State	:	NJ
Zip	:	08873-5125
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5105 GARFIELD ST
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-5103
Country	:	US
Telephone Number	:	619-825-8987
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2019
Last Update Date	:	12/02/2019

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