Provider Demographics
NPI:1174765606
Name:RED HAT AUDIOLOGY, INC.
Entity type:Organization
Organization Name:RED HAT AUDIOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GWYNETH
Authorized Official - Middle Name:WAGNER
Authorized Official - Last Name:NEWCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:301-438-3280
Mailing Address - Street 1:3836 INTERNATIONAL DR
Mailing Address - Street 2:LEISURE WORLD PLAZA
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-1548
Mailing Address - Country:US
Mailing Address - Phone:301-438-3280
Mailing Address - Fax:301-438-3282
Practice Address - Street 1:3836 INTERNATIONAL DR
Practice Address - Street 2:LEISURE WORLD PLAZA
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-1548
Practice Address - Country:US
Practice Address - Phone:301-438-3280
Practice Address - Fax:301-438-3282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00382237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty