Provider Demographics
NPI:1477935682
Name:ATLANTIC NEUROSURGERY PC
Entity Type:Organization
Organization Name:ATLANTIC NEUROSURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NASROLLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FATEHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-460-0455
Mailing Address - Street 1:1020 INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5500
Mailing Address - Country:US
Mailing Address - Phone:757-460-0455
Mailing Address - Fax:757-460-6026
Practice Address - Street 1:1020 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5500
Practice Address - Country:US
Practice Address - Phone:757-460-0455
Practice Address - Fax:757-460-6026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty