Provider Demographics
NPI:1871657189
Name:NEUROLOGY ASSOCIATES MEDICAL GROUP
Entity Type:Organization
Organization Name:NEUROLOGY ASSOCIATES MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:B
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBHAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-776-3566
Mailing Address - Street 1:1751 W ROMNEYA DR
Mailing Address - Street 2:SUITE #J
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1815
Mailing Address - Country:US
Mailing Address - Phone:714-776-3566
Mailing Address - Fax:
Practice Address - Street 1:1751 W ROMNEYA DR
Practice Address - Street 2:SUITE #J
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1815
Practice Address - Country:US
Practice Address - Phone:714-776-3566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33850 & A458202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0101430Medicaid
F51447Medicare UPIN
CAW19093Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
CAGR0101430Medicaid