Provider Demographics
NPI:1225404379
Name:NEUROLOGY ASSOCIATES OF THE EAST VALLEY, PLC
Entity Type:Organization
Organization Name:NEUROLOGY ASSOCIATES OF THE EAST VALLEY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:H
Authorized Official - Last Name:AN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-800-4890
Mailing Address - Street 1:2201 W FAIRVIEW ST
Mailing Address - Street 2:STE 1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4712
Mailing Address - Country:US
Mailing Address - Phone:480-800-4890
Mailing Address - Fax:480-427-4766
Practice Address - Street 1:2201 W FAIRVIEW ST STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4712
Practice Address - Country:US
Practice Address - Phone:480-800-4890
Practice Address - Fax:480-427-4766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ423722084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ179534OtherMEDICARE
AZDW0280OtherRAILROAD MEDICARE
AZ064787Medicaid