Healthcare Provider Details

I. General information

NPI: 1609896067
Provider Name (Legal Business Name): PARKWAY NEUROSCIENCE AND SPINE INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 WESTERN MARYLAND PKWY SUITE 100
HAGERSTOWN MD
21740-5471
US

IV. Provider business mailing address

17 WESTERN MARYLAND PKWY SUITE 100
HAGERSTOWN MD
21740-5471
US

V. Phone/Fax

Practice location:
  • Phone: 301-797-6389
  • Fax:
Mailing address:
  • Phone: 301-797-6389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CINDY A MOSER
Title or Position: BILLING MANAGER
Credential:
Phone: 301-797-6389