Provider Demographics
NPI:1164743092
Name:NEUROLOGY OF CENTRAL MASSACHUSETTS, PC
Entity Type:Organization
Organization Name:NEUROLOGY OF CENTRAL MASSACHUSETTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SRIREKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDUKURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-466-1190
Mailing Address - Street 1:50 MEMORIAL DR
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2238
Mailing Address - Country:US
Mailing Address - Phone:978-466-1190
Mailing Address - Fax:
Practice Address - Street 1:50 MEMORIAL DR
Practice Address - Street 2:SUITE 211
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2238
Practice Address - Country:US
Practice Address - Phone:978-466-1190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty