Provider Demographics
NPI:1821532813
Name:NEUROSCIENCE ASSOCIATES OF BOWIE
Entity Type:Organization
Organization Name:NEUROSCIENCE ASSOCIATES OF BOWIE
Other - Org Name:NEUSAB
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HUDSON-HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:301-852-3479
Mailing Address - Street 1:12416 SKYLARK LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-2121
Mailing Address - Country:US
Mailing Address - Phone:301-852-3479
Mailing Address - Fax:
Practice Address - Street 1:14300 GALLANT FOX LN
Practice Address - Street 2:107
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4003
Practice Address - Country:US
Practice Address - Phone:301-852-3479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty