Provider Demographics
NPI:1356308027
Name:BRISTOL NEUROLOGY, INC
Entity Type:Organization
Organization Name:BRISTOL NEUROLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRICK-MACKINNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-254-6055
Mailing Address - Street 1:10 ORMS ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2228
Mailing Address - Country:US
Mailing Address - Phone:401-453-0666
Mailing Address - Fax:410-453-9619
Practice Address - Street 1:448 HOPE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-1806
Practice Address - Country:US
Practice Address - Phone:401-254-6044
Practice Address - Fax:401-254-0417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty