Provider Demographics
NPI:1891023073
Name:ADVANCED NEUROGERIATRIC CARE PLLC
Entity Type:Organization
Organization Name:ADVANCED NEUROGERIATRIC CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CICERON
Authorized Official - Middle Name:L
Authorized Official - Last Name:OPIDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-946-5000
Mailing Address - Street 1:514 E PLEASANT VALLEY BLVD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-5574
Mailing Address - Country:US
Mailing Address - Phone:814-946-5000
Mailing Address - Fax:814-946-9058
Practice Address - Street 1:514 E PLEASANT VALLEY BLVD
Practice Address - Street 2:SUITE #3
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-5574
Practice Address - Country:US
Practice Address - Phone:814-946-5000
Practice Address - Fax:814-946-9058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020833E261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health