Provider Demographics
NPI:1073570727
Name:NEUROLOGIC ASSOCIATES PC
Entity Type:Organization
Organization Name:NEUROLOGIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:STOVER
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-348-4620
Mailing Address - Street 1:41 E ASHLAND ST
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-4628
Mailing Address - Country:US
Mailing Address - Phone:215-348-4620
Mailing Address - Fax:
Practice Address - Street 1:41 E ASHLAND ST
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-4628
Practice Address - Country:US
Practice Address - Phone:215-348-4620
Practice Address - Fax:215-348-7240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015821E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007254740001Medicaid
PA6161OtherAETNA PROV NUMBER
PA0022237000OtherPROV NUMBER IBC
PAB40728Medicare UPIN
PA0007254740001Medicaid