Provider Demographics
NPI:1952469710
Name:MECKLENBURG NEUROLOGICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:MECKLENBURG NEUROLOGICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN. ASST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:BUTTERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-334-7311
Mailing Address - Street 1:1900 SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6046
Mailing Address - Country:US
Mailing Address - Phone:704-334-7311
Mailing Address - Fax:704-335-9790
Practice Address - Street 1:1900 SCOTT AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6046
Practice Address - Country:US
Practice Address - Phone:704-334-7311
Practice Address - Fax:704-335-9790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0817Medicare ID - Type Unspecified