Provider Demographics
NPI:1275714966
Name:ASSOCIATED NEUROLOGISTS PC
Entity Type:Organization
Organization Name:ASSOCIATED NEUROLOGISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HENNESSEY
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:804-323-1145
Mailing Address - Street 1:1401 JOHNSTON WILLIS DR
Mailing Address - Street 2:THE ATRIUM SUITE 5300
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4730
Mailing Address - Country:US
Mailing Address - Phone:804-323-1145
Mailing Address - Fax:804-272-1903
Practice Address - Street 1:1401 JOHNSTON WILLIS DR
Practice Address - Street 2:THE ATRIUM SUITE 5300
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4730
Practice Address - Country:US
Practice Address - Phone:804-323-1145
Practice Address - Fax:804-272-1903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031272174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA012879OtherBLUE CROSS BLUE SHIELD
VA130000057OtherMEDICARE ID TYPE UNSPECIF
VA006195334Medicaid
VA220633OtherOPTIMUM CHOICE
VAC09633OtherGROUP PTAN BON SECOURS
VA006504OtherBLUE CROSS BLUE SHIELD GR
VA130000057OtherMEDICARE ID TYPE UNSPECIF
VA006195334Medicaid