Provider Demographics
NPI:1285651125
Name:NEUROLOGY CONSULTANTS CORP
Entity Type:Organization
Organization Name:NEUROLOGY CONSULTANTS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNEETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-635-3275
Mailing Address - Street 1:PO BOX 7534
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22106-7534
Mailing Address - Country:US
Mailing Address - Phone:703-635-3275
Mailing Address - Fax:703-286-5096
Practice Address - Street 1:8303 ARLINGTON BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2903
Practice Address - Country:US
Practice Address - Phone:703-635-3275
Practice Address - Fax:703-286-5096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101235954174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010259703Medicaid
G02251Medicare ID - Type Unspecified
VA010259703Medicaid