MEDICARE: NORTHERN VIRGINIA AUDIOLOGY DOCTORS

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	231H00000X	Audiologist

General Provider Information

NPI Number	:	1982595559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN VIRGINIA AUDIOLOGY DOCTORS

Provider Business Mailing Address
First Line	:	1511 BELLE VIEW BLVD APT B1
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307-6715
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	918 PRINCE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-3020
Country	:	US
Telephone Number	:	571-775-3407
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANTOINETTE OLIVER
Credential	:
Telephone Number	:	410-869-6625

Provider Enumeration Date	:	07/11/2025
Last Update Date	:	08/04/2025

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