Healthcare Provider Details

I. General information

NPI: 1629402557
Provider Name (Legal Business Name): COMMUNITY NEUROLOGY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 HICKORY RIDGE RD
COLUMBIA MD
21044-3622
US

IV. Provider business mailing address

10810 HICKORY RIDGE RD
COLUMBIA MD
21044-3622
US

V. Phone/Fax

Practice location:
  • Phone: 410-997-5500
  • Fax: 410-997-4150
Mailing address:
  • Phone: 410-997-5500
  • Fax: 410-997-4150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberD0037205
License Number StateMD

VIII. Authorized Official

Name: MRS. DARSHANA DAVE
Title or Position: OFFICE MANAGER
Credential:
Phone: 410-997-5500