Healthcare Provider Details

I. General information

NPI: 1619635018
Provider Name (Legal Business Name): COMPREHENSIVE NEURO SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19415 DEERFIELD AVE STE 310
LANSDOWNE VA
20176-8472
US

IV. Provider business mailing address

PO BOX 6529
MCKINNEY TX
75071-5114
US

V. Phone/Fax

Practice location:
  • Phone: 844-212-5321
  • Fax: 214-975-2270
Mailing address:
  • Phone: 844-212-5321
  • Fax: 214-975-2270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: FRANK GRAY III
Title or Position: DIRECTOR
Credential:
Phone: 844-212-5321