Provider Demographics
NPI:1124007778
Name:METROLINA NEUROLOGICAL ASSOCIATES, P A
Entity Type:Organization
Organization Name:METROLINA NEUROLOGICAL ASSOCIATES, P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-980-7948
Mailing Address - Street 1:1665 HERLONG COURT
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732
Mailing Address - Country:US
Mailing Address - Phone:803-980-7930
Mailing Address - Fax:803-366-6155
Practice Address - Street 1:1665 HERLONG COURT
Practice Address - Street 2:SUITE B
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732
Practice Address - Country:US
Practice Address - Phone:803-980-7930
Practice Address - Fax:803-366-6155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA8722Medicaid
SC2435Medicare PIN