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General NPI Number Information
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NPI Number | 1174829832
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Entity Type | Organization
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Legal Business Name | PRINCE WILLIAM NEUROLOGY CENTER INC
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Dates
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Enumeration Date | 01/28/2011
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Last Update Date | 01/28/2011
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Provider Practice Location Address
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Address Line | 14401 HEREFORD RD
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City | WOODBRIDGE
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State | VA
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Zip | 22193-2128
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Country | US
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Telephone | 703-670-9553
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Fax | 703-670-0483
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Provider Business Mailing Address
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Address Line | 14401 HEREFORD RD
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City | WOODBRIDGE
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State | VA
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Zip | 22193-2128
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Country | US
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Telephone | 703-670-9553
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Fax | 703-670-0483
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NAURANG S GILL
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Credential | MD
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Telephone | 703-670-9553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 0101033757
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License Number State | VA
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