Provider Demographics
NPI:1316119555
Name:CONRAD, MARYBETH SCHERER (AUDIOLOGIST)
Entity type:Individual
Prefix:MS
First Name:MARYBETH
Middle Name:SCHERER
Last Name:CONRAD
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 LILLINGTON AVENUE
Mailing Address - Street 2:HEARUSA
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-5400
Mailing Address - Country:US
Mailing Address - Phone:704-332-1574
Mailing Address - Fax:704-295-3468
Practice Address - Street 1:302 LILLINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-5400
Practice Address - Country:US
Practice Address - Phone:704-295-3300
Practice Address - Fax:704-295-3468
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6585231H00000X
NC1184237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4108944OtherCIGNA
NC7413292Medicaid
SCSAN072Medicaid
NC1618NOtherBCBSNC
0009361225OtherAETNA
SCSAN072Medicaid