Provider Demographics
NPI:1093729774
Name:ADVANCED NEUROLOGY ASSOCIATES INC
Entity Type:Organization
Organization Name:ADVANCED NEUROLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAMULONIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:330-746-7400
Mailing Address - Street 1:1340 BELMONT AVE
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1125
Mailing Address - Country:US
Mailing Address - Phone:330-746-7400
Mailing Address - Fax:330-746-7436
Practice Address - Street 1:1340 BELMONT AVE
Practice Address - Street 2:SUITE 2200
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1125
Practice Address - Country:US
Practice Address - Phone:330-746-7400
Practice Address - Fax:330-746-7436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2960194Medicaid
OH2960167Medicaid
OH0557026Medicaid
OHMCNS03831Medicare PIN
OHNS04381Medicare PIN
Q77281Medicare UPIN
OH0533934Medicare ID - Type Unspecified
OHSONS01761Medicare ID - Type Unspecified