Provider Demographics
NPI:1730557265
Name:PHYSICIANS AUDIOLOGY CENTER, LLC.
Entity type:Organization
Organization Name:PHYSICIANS AUDIOLOGY CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRASAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-493-9409
Mailing Address - Street 1:1101 WOOTTON PKWY
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1059
Mailing Address - Country:US
Mailing Address - Phone:301-493-9409
Mailing Address - Fax:301-493-9429
Practice Address - Street 1:1101 WOOTTON PKWY
Practice Address - Street 2:SUITE 900
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1059
Practice Address - Country:US
Practice Address - Phone:301-493-9409
Practice Address - Fax:301-493-9429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0101048706231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1568745750OtherNPI
MD1962762674OtherNPI
MD1548524168OtherNPI