Healthcare Provider Details

I. General information

NPI: 1699168567
Provider Name (Legal Business Name): PRECISION NEUROMONITORING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 YORK RD STE 210
BALTIMORE MD
21212-2024
US

IV. Provider business mailing address

6600 YORK RD STE 210
BALTIMORE MD
21212-2024
US

V. Phone/Fax

Practice location:
  • Phone: 410-983-9246
  • Fax: 410-995-2124
Mailing address:
  • Phone: 410-983-9246
  • Fax: 410-995-2124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: THIERRY CHANEY
Title or Position: CEO
Credential:
Phone: 703-371-4492