Basic Information
| Provider Information | |||||||||
| NPI: | 1871058446 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDATLANTIC NEUROMONITORING LIMITED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15312 SPENCERVILLE CT STE 201 | ||||||||
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| City: | BURTONSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208666609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013700810 | ||||||||
| FaxNumber: | 2403422801 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 HALF MILE RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | RED BANK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077016749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013700810 | ||||||||
| FaxNumber: | 2403422801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2019 | ||||||||
| LastUpdateDate: | 02/07/2019 | ||||||||
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| AuthorizedOfficialLastName: | THOMAS | ||||||||
| AuthorizedOfficialFirstName: | VERNON | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3013700810 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.