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General NPI Number Information
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NPI Number | 1194983569
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Entity Type | Organization
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Legal Business Name | NEUROLOGY CENTER OF VIRGINIA, LLC
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Dates
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Enumeration Date | 06/01/2008
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Last Update Date | 04/27/2012
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Provider Practice Location Address
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Address Line | 2436 COLONY CROSSING PL
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-4281
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Country | US
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Telephone | 804-302-4400
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Fax | 804-601-2515
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Provider Business Mailing Address
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Address Line | 16718 KIPPER TURN
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City | MOSELEY
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State | VA
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Zip | 23120-2222
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Country | US
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Telephone | 804-302-4400
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Fax |
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Authorized Official
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Title or Position | NEUROLOGIST/MEMBER
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Name | DR. HERNAN TAPIA GATUSLAO JR.
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Credential | M.D.
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Telephone | 804-302-4400
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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 |
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License Number State |
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