Provider Demographics
NPI:1558773929
Name:SIGNATURE NEUROLOGY LLC
Entity Type:Organization
Organization Name:SIGNATURE NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HARI
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-364-3282
Mailing Address - Street 1:47 CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1006
Mailing Address - Country:US
Mailing Address - Phone:610-761-7438
Mailing Address - Fax:610-744-2420
Practice Address - Street 1:47 CAMBRIDGE RD
Practice Address - Street 2:
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1006
Practice Address - Country:US
Practice Address - Phone:610-761-7438
Practice Address - Fax:610-744-2420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-042757-L103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty