Provider Demographics
NPI:1376522896
Name:SOUTHAMPTON NEUROLOGY PC
Entity Type:Organization
Organization Name:SOUTHAMPTON NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:HIGHLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-569-9524
Mailing Address - Street 1:177 COMMERCE PARK ROAD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-1226
Mailing Address - Country:US
Mailing Address - Phone:757-569-9524
Mailing Address - Fax:757-569-0504
Practice Address - Street 1:177 COMMERCE PARK ROAD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-1226
Practice Address - Country:US
Practice Address - Phone:757-569-9524
Practice Address - Fax:757-569-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010499032084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA282814OtherANTHEM
VA010151091Medicaid
VA010151104Medicaid
VAG25570Medicare UPIN
VAC10629Medicare PIN