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General NPI Number Information
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NPI Number | 1144491754
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Entity Type | Organization
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Legal Business Name | NEUROLOGY PA LLC
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Dates
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Enumeration Date | 03/23/2008
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Last Update Date | 09/03/2008
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Provider Practice Location Address
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Address Line | 1500 LOCUST ST 4406
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City | PHILADELPHIA
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State | PA
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Zip | 19102-4329
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Country | US
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Telephone | 610-331-6942
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Fax | 215-875-8324
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Provider Business Mailing Address
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Address Line | PO BOX 42313
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City | PHILADELPHIA
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State | PA
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Zip | 19101-2313
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Country | US
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Telephone | 610-331-6942
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Fax | 215-875-8324
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Authorized Official
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Title or Position | MD
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Name | SHAHLA VAKILI
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Credential | MD
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Telephone | 610-331-6942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1860
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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