Provider Demographics
NPI:1609994946
Name:TOWSON NEUROLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:TOWSON NEUROLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-321-6055
Mailing Address - Street 1:120 SISTER PIERRE DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7516
Mailing Address - Country:US
Mailing Address - Phone:410-321-6055
Mailing Address - Fax:410-321-6056
Practice Address - Street 1:120 SISTER PIERRE DR
Practice Address - Street 2:SUITE 109
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7516
Practice Address - Country:US
Practice Address - Phone:410-321-6055
Practice Address - Fax:410-321-6056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0018197174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH54427Medicare UPIN
MDG65693Medicare UPIN
MDD01312Medicare UPIN