Provider Demographics
NPI:1023127081
Name:NEUROLOGICAL ASSOCIATES OF VT
Entity type:Organization
Organization Name:NEUROLOGICAL ASSOCIATES OF VT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ACKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-862-5759
Mailing Address - Street 1:89 S WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3405
Mailing Address - Country:US
Mailing Address - Phone:802-862-5759
Mailing Address - Fax:802-658-0680
Practice Address - Street 1:89 S WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3405
Practice Address - Country:US
Practice Address - Phone:802-862-5759
Practice Address - Fax:802-658-0680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00004695OtherBLUE CROSS BLUE SHIELD
VT0004695Medicaid
VT00004695OtherBLUE CROSS BLUE SHIELD