Provider Demographics
NPI:1811072838
Name:CONWAY NEUROLOGY PA
Entity type:Organization
Organization Name:CONWAY NEUROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:O
Authorized Official - Last Name:OBERLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-505-0400
Mailing Address - Street 1:PO BOX 11078
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-0019
Mailing Address - Country:US
Mailing Address - Phone:501-860-6130
Mailing Address - Fax:501-860-6054
Practice Address - Street 1:400 SALEM RD
Practice Address - Street 2:BLDG 3 SUITE 1
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6162
Practice Address - Country:US
Practice Address - Phone:501-505-0400
Practice Address - Fax:501-505-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134556002Medicaid
ARE0479OtherELECTRONIC SUBMITTER
AR5K817Medicare ID - Type Unspecified