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General NPI Number Information
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NPI Number | 1700166360
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Entity Type | Organization
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Legal Business Name | NEUROLOGY CLINIC OF MARYLAND, INC.
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Dates
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Enumeration Date | 08/26/2011
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Last Update Date | 08/26/2011
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Provider Practice Location Address
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Address Line | 10770 HICKORY RIDGE RD
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City | COLUMBIA
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State | MD
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Zip | 21044-3646
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Country | US
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Telephone | 410-988-4013
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Fax |
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Provider Business Mailing Address
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Address Line | 10770 HICKORY RIDGE RD
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City | COLUMBIA
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State | MD
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Zip | 21044-3646
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Country | US
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Telephone | 410-988-4013
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. SHEETAL HARISH WAGLE
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Credential | MD
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Telephone | 410-988-4013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | D0072106
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License Number State | MD
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