Basic Information
| Provider Information | |||||||||
| NPI: | 1730557265 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIANS AUDIOLOGY CENTER, LLC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 WOOTTON PKWY | ||||||||
| Address2: | SUITE 900 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208521059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014939409 | ||||||||
| FaxNumber: | 3014939429 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 WOOTTON PKWY | ||||||||
| Address2: | SUITE 900 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208521059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014939409 | ||||||||
| FaxNumber: | 3014939429 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2015 | ||||||||
| LastUpdateDate: | 09/15/2015 | ||||||||
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| AuthorizedOfficialLastName: | PRASAD | ||||||||
| AuthorizedOfficialFirstName: | SANJAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3014939409 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 0101048706 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 1568745750 | 01 | MD | NPI | OTHER | 1962762674 | 01 | MD | NPI | OTHER | 1548524168 | 01 | MD | NPI | OTHER |