Provider Demographics
NPI:1982895462
Name:DANVILLE NEUROLOGY & SLEEP CENTER
Entity Type:Organization
Organization Name:DANVILLE NEUROLOGY & SLEEP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:MUGABALA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ASWATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-792-3131
Mailing Address - Street 1:130 GRAY ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-2942
Mailing Address - Country:US
Mailing Address - Phone:434-792-3131
Mailing Address - Fax:434-792-3303
Practice Address - Street 1:130 GRAY ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2942
Practice Address - Country:US
Practice Address - Phone:434-792-3131
Practice Address - Fax:434-792-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058334174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1134323801OtherINDIVIDUAL NPI
VA7114681Medicaid