Basic Information
| Provider Information | |||||||||
| NPI: | 1619164142 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEUROLOGY OFFICE, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3500 OLD WASHINGTON RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | WALDORF | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206023224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018432222 | ||||||||
| FaxNumber: | 3019349321 | ||||||||
| Practice Location | |||||||||
| Address1: | 3500 OLD WASHINGTON RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | WALDORF | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206023224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018432222 | ||||||||
| FaxNumber: | 3019349321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2007 | ||||||||
| LastUpdateDate: | 09/28/2007 | ||||||||
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| AuthorizedOfficialLastName: | NANDIPATI | ||||||||
| AuthorizedOfficialFirstName: | S | ||||||||
| AuthorizedOfficialMiddleName: | KIRSHNA | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3018432222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | D38160 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | G939 | 01 | DC | BLUE CROSS | OTHER |