Provider Demographics
NPI:1356466460
Name:SPRINGFIELD NEUROLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SPRINGFIELD NEUROLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-781-5000
Mailing Address - Street 1:300 CAREW ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2485
Mailing Address - Country:US
Mailing Address - Phone:413-781-5050
Mailing Address - Fax:413-781-2510
Practice Address - Street 1:300 CAREW ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2485
Practice Address - Country:US
Practice Address - Phone:413-781-5050
Practice Address - Fax:413-781-2510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9725750Medicaid
MA9725750Medicaid