Provider Demographics
NPI:1316917693
Name:ASHBROOK, PAUL EDWARD (MS, CCC-A, FAAA03)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:EDWARD
Last Name:ASHBROOK
Suffix:
Gender:M
Credentials:MS, CCC-A, FAAA03
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-4508
Mailing Address - Country:US
Mailing Address - Phone:276-666-0401
Mailing Address - Fax:276-666-0045
Practice Address - Street 1:1111 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-4508
Practice Address - Country:US
Practice Address - Phone:276-666-0401
Practice Address - Fax:276-666-0045
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001180174400000X
VA2101-001212174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2101-001212OtherHEARING AID DEALER
VA2201001180OtherAUDIOLOGIST LICENSE #
VA136675OtherANTHEM
VA2201001180OtherAUDIOLOGIST LICENSE #
VAP65913Medicare UPIN