Provider Demographics
NPI:1477648251
Name:NEUROLOGY ASSOCIATES OF W PA
Entity Type:Organization
Organization Name:NEUROLOGY ASSOCIATES OF W PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:P
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-224-2083
Mailing Address - Street 1:985 PENN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRACKENRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15014-1160
Mailing Address - Country:US
Mailing Address - Phone:724-224-2083
Mailing Address - Fax:724-224-2860
Practice Address - Street 1:985 PENN ST
Practice Address - Street 2:SUITE A
Practice Address - City:BRACKENRIDGE
Practice Address - State:PA
Practice Address - Zip Code:15014-1160
Practice Address - Country:US
Practice Address - Phone:724-224-2083
Practice Address - Fax:724-224-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017633E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007276570003Medicaid
PA146405Medicare ID - Type Unspecified