Provider Demographics
NPI:1609333145
Name:NEUROLOGY ASSOCIATES OF THE MAIN LINE
Entity Type:Organization
Organization Name:NEUROLOGY ASSOCIATES OF THE MAIN LINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-639-2555
Mailing Address - Street 1:2417 WELSH RD STE 220
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2214
Mailing Address - Country:US
Mailing Address - Phone:267-639-2555
Mailing Address - Fax:215-613-5631
Practice Address - Street 1:1413 W MOYAMENSING AVE FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-4625
Practice Address - Country:US
Practice Address - Phone:267-639-2555
Practice Address - Fax:215-613-5631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty