Provider Demographics
NPI:1710344718
Name:STAFFORD NEUROLOGY
Entity Type:Organization
Organization Name:STAFFORD NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-658-0825
Mailing Address - Street 1:24 ONVILLE RD
Mailing Address - Street 2:STE 205
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-3831
Mailing Address - Country:US
Mailing Address - Phone:540-658-0825
Mailing Address - Fax:540-658-0835
Practice Address - Street 1:24 ONVILLE RD
Practice Address - Street 2:STE 205
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-3831
Practice Address - Country:US
Practice Address - Phone:540-658-0825
Practice Address - Fax:540-658-0835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010329922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB10310Medicare UPIN