Provider Demographics
NPI:1255052668
Name:GM NEUROLOGIC HEALTH ASSOCIATES LLC
Entity type:Organization
Organization Name:GM NEUROLOGIC HEALTH ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER /PROPRITOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GANGADHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MADUPU
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MS
Authorized Official - Phone:717-333-0366
Mailing Address - Street 1:2119 MARIETTA AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2207
Mailing Address - Country:US
Mailing Address - Phone:717-200-1122
Mailing Address - Fax:717-745-3824
Practice Address - Street 1:2119 MARIETTA AVE STE 1
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2207
Practice Address - Country:US
Practice Address - Phone:717-200-1122
Practice Address - Fax:717-745-3824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty