Provider Demographics
NPI:1114958287
Name:MARTINSVILLE NEUROLOGICAL ASSOC., INC
Entity Type:Organization
Organization Name:MARTINSVILLE NEUROLOGICAL ASSOC., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-632-4181
Mailing Address - Street 1:101 CLEVELAND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-3700
Mailing Address - Country:US
Mailing Address - Phone:276-632-4181
Mailing Address - Fax:276-632-1559
Practice Address - Street 1:101 CLEVELAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-3700
Practice Address - Country:US
Practice Address - Phone:276-632-4181
Practice Address - Fax:276-632-1559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC04168OtherMEDICARE GROUP PROVIDER #
VAC04168OtherMEDICARE GROUP PROVIDER #
VAH38869Medicare UPIN
VAB45636Medicare UPIN