Provider Demographics
NPI:1689301129
Name:FLAGSHIP NEUROPSYCHOLOGY PLLC
Entity Type:Organization
Organization Name:FLAGSHIP NEUROPSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ABPP-CN
Authorized Official - Phone:814-622-4894
Mailing Address - Street 1:1001 STATE ST STE 1400
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1834
Mailing Address - Country:US
Mailing Address - Phone:148-622-4894
Mailing Address - Fax:814-298-6401
Practice Address - Street 1:1001 STATE ST STE 1400
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1834
Practice Address - Country:US
Practice Address - Phone:148-622-4894
Practice Address - Fax:814-298-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty