Provider Demographics
NPI:1497512321
Name:MANSFIELD NEUROLOGY ASSOCIATES PLLC
Entity type:Organization
Organization Name:MANSFIELD NEUROLOGY ASSOCIATES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GANANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TESFA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-688-4451
Mailing Address - Street 1:2800 E BROAD ST STE 517
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6417
Mailing Address - Country:US
Mailing Address - Phone:817-688-4451
Mailing Address - Fax:817-549-5151
Practice Address - Street 1:2800 E BROAD ST STE 517
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6417
Practice Address - Country:US
Practice Address - Phone:817-688-4451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-06
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty