Basic Information
Provider Information | |||||||||
NPI: | 1629580089 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | A & A HEARING GROUP, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | LIVE BETTER HEARING | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 19110 MONTGOMERY VILLAGE AVE STE 120 | ||||||||
Address2: |   | ||||||||
City: | MONTGOMERY VILLAGE | ||||||||
State: | MD | ||||||||
PostalCode: | 208863706 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3019776317 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 12800 MIDDLEBROOK RD STE 100 | ||||||||
Address2: |   | ||||||||
City: | GERMANTOWN | ||||||||
State: | MD | ||||||||
PostalCode: | 208745204 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3013292731 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/25/2017 | ||||||||
LastUpdateDate: | 10/25/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CUSHING | ||||||||
AuthorizedOfficialFirstName: | ROSS | ||||||||
AuthorizedOfficialMiddleName: | EMERSON | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER/AUDIOLOGIST | ||||||||
AuthorizedOfficialTelephone: | 3013581833 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X |   | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |   |
No ID Information.