Provider Demographics
NPI:1932167566
Name:NEUROLOGICAL SPECIALTIES NEUROLOGY PA
Entity Type:Organization
Organization Name:NEUROLOGICAL SPECIALTIES NEUROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-876-6321
Mailing Address - Street 1:2816 W VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6330
Mailing Address - Country:US
Mailing Address - Phone:813-876-6321
Mailing Address - Fax:813-870-0350
Practice Address - Street 1:2816 W VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6330
Practice Address - Country:US
Practice Address - Phone:813-876-6321
Practice Address - Fax:813-870-0350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1932167566OtherNPI
21271OtherMEDICARE GROUP NUMBER
FL21271OtherBCBS OF FLORIDA GROUP NUM
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