Provider Demographics
NPI:1205950656
Name:MARYLAND NEUROLOGICAL CENTER, LLC
Entity type:Organization
Organization Name:MARYLAND NEUROLOGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GEARHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-730-1212
Mailing Address - Street 1:11085 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2983
Mailing Address - Country:US
Mailing Address - Phone:410-730-1212
Mailing Address - Fax:410-730-2812
Practice Address - Street 1:11085 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 212
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2983
Practice Address - Country:US
Practice Address - Phone:410-730-1212
Practice Address - Fax:410-730-2812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty