Provider Demographics
NPI:1619164142
Name:NEUROLOGY OFFICE, PC
Entity Type:Organization
Organization Name:NEUROLOGY OFFICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:S
Authorized Official - Middle Name:KIRSHNA
Authorized Official - Last Name:NANDIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-843-2222
Mailing Address - Street 1:3500 OLD WASHINGTON RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3224
Mailing Address - Country:US
Mailing Address - Phone:301-843-2222
Mailing Address - Fax:301-934-9321
Practice Address - Street 1:3500 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3224
Practice Address - Country:US
Practice Address - Phone:301-843-2222
Practice Address - Fax:301-934-9321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD38160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG939OtherBLUE CROSS
MDB06178Medicare UPIN
VAC08926Medicare PIN
MD721MMedicare PIN