Provider Demographics
NPI:1821798349
Name:VIENNA NEUROLOGICAL INSTITUTE PLLC
Entity Type:Organization
Organization Name:VIENNA NEUROLOGICAL INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-220-4845
Mailing Address - Street 1:8245 BOONE BLVD STE 540
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3847
Mailing Address - Country:US
Mailing Address - Phone:813-220-4845
Mailing Address - Fax:
Practice Address - Street 1:8245 BOONE BLVD STE 540
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3847
Practice Address - Country:US
Practice Address - Phone:813-220-4845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty