Provider Demographics
NPI:1003907965
Name:PENNSYLVANIA NEUROLOGICAL ASSOCIATES LTD
Entity Type:Organization
Organization Name:PENNSYLVANIA NEUROLOGICAL ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:NULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-774-2202
Mailing Address - Street 1:110 LOWTHER ST
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-2012
Mailing Address - Country:US
Mailing Address - Phone:717-774-2202
Mailing Address - Fax:717-774-2634
Practice Address - Street 1:110 LOWTHER ST
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-2012
Practice Address - Country:US
Practice Address - Phone:717-774-2202
Practice Address - Fax:717-774-2634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045352E2084N0400X
PAMD046124L2084N0400X
PAMD069690L2084N0400X
PAMD073033L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1083679559OtherNPI INDIV
1174588644OtherNPI INDIV
049923NOCOtherMEDICARE ID
1861456675OtherNPI INDIV
1427009521OtherINDIVIDUAL NPI
H44715Medicare UPIN
H32054Medicare UPIN
597825HQLMedicare ID - Type Unspecified
1427009521OtherINDIVIDUAL NPI
049923NOCOtherMEDICARE ID
1174588644OtherNPI INDIV
1083679559OtherNPI INDIV