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General NPI Number Information
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NPI Number | 1154665198
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Entity Type | Organization
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Legal Business Name | ATLANTIC NEURODIAGNOSTICS LLC
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 1512 KING WILLIAM DR
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City | BALTIMORE
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State | MD
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Zip | 21228-1001
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Country | US
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Telephone | 443-351-7879
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1610
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City | FORT MEADE
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State | MD
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Zip | 20755-3610
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Country | US
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Telephone | 443-351-7879
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | ED WOODS
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Credential |
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Telephone | 301-714-1802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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