Provider Demographics
NPI:1780639369
Name:NEUROLOGY CARE CENTER PA
Entity Type:Organization
Organization Name:NEUROLOGY CARE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:CAMBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-628-2273
Mailing Address - Street 1:PO BOX 5741
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32793-5741
Mailing Address - Country:US
Mailing Address - Phone:407-628-2273
Mailing Address - Fax:407-628-1025
Practice Address - Street 1:2828 CASA ALOMA WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2223
Practice Address - Country:US
Practice Address - Phone:407-628-2273
Practice Address - Fax:407-628-1025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4859Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER