Provider Demographics
NPI:1780952366
Name:ADVANCED NEUROLOGY CARE CENTER PC
Entity type:Organization
Organization Name:ADVANCED NEUROLOGY CARE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASWINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:KHOSLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-349-6690
Mailing Address - Street 1:3301 WOODBURN RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1229
Mailing Address - Country:US
Mailing Address - Phone:703-349-6690
Mailing Address - Fax:703-652-4358
Practice Address - Street 1:10125 COLESVILLE RD
Practice Address - Street 2:SUITE 194
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-2457
Practice Address - Country:US
Practice Address - Phone:703-349-6690
Practice Address - Fax:703-652-4358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238882207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101238882OtherMEDICAL LICENSE