Provider Demographics
NPI:1417218090
Name:ADVANCED NEUROLOGICAL DIAGNOSTICS, INC.
Entity Type:Organization
Organization Name:ADVANCED NEUROLOGICAL DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-373-1971
Mailing Address - Street 1:1921 WALDEMERE ST
Mailing Address - Street 2:STE 810
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2943
Mailing Address - Country:US
Mailing Address - Phone:941-373-1971
Mailing Address - Fax:941-894-1176
Practice Address - Street 1:1921 WALDEMERE ST
Practice Address - Street 2:STE 810
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2943
Practice Address - Country:US
Practice Address - Phone:941-373-1971
Practice Address - Fax:941-894-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1131162084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGK217AMedicare PIN