Basic Information
| Provider Information | |||||||||
| NPI: | 1477603157 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEUROLOGICAL ASSOCIATES OF HAMPTON ROADS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 MEDICAL PKWY | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233204985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575470508 | ||||||||
| FaxNumber: | 7575478963 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 MEDICAL PKWY | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233204985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575470508 | ||||||||
| FaxNumber: | 7575478963 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 11/20/2007 | ||||||||
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| AuthorizedOfficialLastName: | SNIDER | ||||||||
| AuthorizedOfficialFirstName: | GILBERT | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7575470508 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 0101034247 | VA | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 174400000X | 0101040999 | VA | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 174400000X | 0101052787 | VA | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.