Healthcare Provider Details

I. General information

NPI: 1962620690
Provider Name (Legal Business Name): NEUROLOGY CONSULTANT, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 MILL ST SUITE 1
HAGERSTOWN MD
21740-6114
US

IV. Provider business mailing address

235 MILL ST SUITE 1
HAGERSTOWN MD
21740-6114
US

V. Phone/Fax

Practice location:
  • Phone: 301-739-5959
  • Fax: 301-739-2403
Mailing address:
  • Phone: 301-739-5959
  • Fax: 301-739-2403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0055626
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SAMINA ANWAR
Title or Position: DOCTOR
Credential: MD
Phone: 301-739-5959