Provider Demographics
NPI:1952656159
Name:CNMRI PA
Entity Type:Organization
Organization Name:CNMRI PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-346-2491
Mailing Address - Street 1:1074 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-6925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1095 S BRADFORD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4141
Practice Address - Country:US
Practice Address - Phone:302-678-8100
Practice Address - Fax:888-990-1108
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CNMRI PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-13
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty