Provider Demographics
NPI:1336383835
Name:LANHAM NEURO SCIENCE CENTER LLC
Entity Type:Organization
Organization Name:LANHAM NEURO SCIENCE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIMELLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEMAYEHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-552-6666
Mailing Address - Street 1:9801 GREENBELT RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2273
Mailing Address - Country:US
Mailing Address - Phone:301-552-6666
Mailing Address - Fax:301-552-6216
Practice Address - Street 1:9801 GREENBELT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2273
Practice Address - Country:US
Practice Address - Phone:301-552-6666
Practice Address - Fax:301-552-6216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare PIN