Healthcare Provider Details

I. General information

NPI: 1063517753
Provider Name (Legal Business Name): PANHANDLE NEUROLOGY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 06/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 HEALTH CARE LN
MARTINSBURG WV
25401-4009
US

IV. Provider business mailing address

156 HEALTH CARE LN
MARTINSBURG WV
25401-4009
US

V. Phone/Fax

Practice location:
  • Phone: 304-264-0704
  • Fax: 304-264-0804
Mailing address:
  • Phone: 304-264-0704
  • Fax: 304-264-0804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number21572
License Number StateWV

VIII. Authorized Official

Name: DR. KAROLY VARGA
Title or Position: PRESIDENT
Credential: M.D., PH.D.
Phone: 304-264-0704