Provider Demographics
NPI:1417137787
Name:METROLINA NEUROLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:METROLINA NEUROLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-366-6135
Mailing Address - Street 1:10620 PARK RD STE 230
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-0106
Mailing Address - Country:US
Mailing Address - Phone:704-542-6698
Mailing Address - Fax:
Practice Address - Street 1:10620 PARK RD STE 230
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-0106
Practice Address - Country:US
Practice Address - Phone:704-542-6698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7902900Medicaid
NC1125Medicare PIN