Provider Demographics
NPI:1851574644
Name:SOUTHWEST PA NEUROLOGY, LLC
Entity Type:Organization
Organization Name:SOUTHWEST PA NEUROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARUNA
Authorized Official - Middle Name:SREE
Authorized Official - Last Name:MANDAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-838-0090
Mailing Address - Street 1:426 PELLIS RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-4574
Mailing Address - Country:US
Mailing Address - Phone:724-838-0090
Mailing Address - Fax:724-838-7717
Practice Address - Street 1:426 PELLIS RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-4574
Practice Address - Country:US
Practice Address - Phone:724-838-0090
Practice Address - Fax:724-838-7717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072721L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty