Provider Demographics
NPI:1114953361
Name:NEUROLOGY AND STROKE ASSOC.
Entity Type:Organization
Organization Name:NEUROLOGY AND STROKE ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VENKATACHALAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGESHKUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-569-8773
Mailing Address - Street 1:640 EAST OREGON ROAD
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543
Mailing Address - Country:US
Mailing Address - Phone:717-569-8773
Mailing Address - Fax:717-569-8187
Practice Address - Street 1:640 EAST OREGON ROAD
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543
Practice Address - Country:US
Practice Address - Phone:717-569-8773
Practice Address - Fax:717-569-8187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
PAMD061259L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016722400Medicaid
PA0016722400Medicaid
PAG65164Medicare UPIN