Provider Demographics
NPI:1477603157
Name:NEUROLOGICAL ASSOCIATES OF HAMPTON ROADS
Entity Type:Organization
Organization Name:NEUROLOGICAL ASSOCIATES OF HAMPTON ROADS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-547-0508
Mailing Address - Street 1:300 MEDICAL PKWY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4985
Mailing Address - Country:US
Mailing Address - Phone:757-547-0508
Mailing Address - Fax:757-547-8963
Practice Address - Street 1:300 MEDICAL PKWY
Practice Address - Street 2:SUITE 212
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4985
Practice Address - Country:US
Practice Address - Phone:757-547-0508
Practice Address - Fax:757-547-8963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034247174400000X
VA0101040999174400000X
VA0101052787174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05872Medicare PIN
VACN9853Medicare PIN