Provider Demographics
NPI:1235554502
Name:NORTHWEST NEUROLOGY, PLLC
Entity Type:Organization
Organization Name:NORTHWEST NEUROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:SEALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-838-7111
Mailing Address - Street 1:1520 MEADOWVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-7348
Mailing Address - Country:US
Mailing Address - Phone:336-838-7111
Mailing Address - Fax:336-838-4299
Practice Address - Street 1:1520 MEADOWVIEW DR
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-7348
Practice Address - Country:US
Practice Address - Phone:336-838-7111
Practice Address - Fax:336-838-4299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC357482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1952393605OtherINDIVIDUAL NPI
2173867OtherNC MEDICARE PTAN