Provider Demographics
NPI:1497988836
Name:NEUROLOGICAL MEDICINE, P.A.
Entity Type:Organization
Organization Name:NEUROLOGICAL MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEAHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-982-7944
Mailing Address - Street 1:7500 HANOVER PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2010
Mailing Address - Country:US
Mailing Address - Phone:301-982-7944
Mailing Address - Fax:301-441-8696
Practice Address - Street 1:180 ADMIRAL COCHRANE DR
Practice Address - Street 2:SUITE 260
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7300
Practice Address - Country:US
Practice Address - Phone:301-982-7944
Practice Address - Fax:301-441-8696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD912931600Medicaid
MD176498Medicare PIN