Provider Demographics
NPI:1497512321
Name:MANSFIELD NEUROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:MANSFIELD NEUROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GANANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TESFA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-688-4451
Mailing Address - Street 1:100 BALD CYPRESS CIR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-8413
Mailing Address - Country:US
Mailing Address - Phone:817-688-4451
Mailing Address - Fax:
Practice Address - Street 1:2800 E BROAD ST STE 517
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6417
Practice Address - Country:US
Practice Address - Phone:817-688-4451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty