Provider Demographics
NPI:1598717928
Name:ROANOKE NEUROLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:ROANOKE NEUROLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:BANDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-342-0211
Mailing Address - Street 1:4461 STARKEY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0620
Mailing Address - Country:US
Mailing Address - Phone:540-342-0211
Mailing Address - Fax:540-344-5543
Practice Address - Street 1:4461 STARKEY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0620
Practice Address - Country:US
Practice Address - Phone:540-342-0211
Practice Address - Fax:540-344-5543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC03992Medicare ID - Type Unspecified