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General NPI Number Information
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NPI Number | 1851574644
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Entity Type | Organization
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Legal Business Name | SOUTHWEST PA NEUROLOGY, LLC
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Dates
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Enumeration Date | 12/14/2007
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Last Update Date | 12/14/2007
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Provider Practice Location Address
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Address Line | 426 PELLIS RD
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City | GREENSBURG
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State | PA
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Zip | 15601-4574
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Country | US
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Telephone | 724-838-0090
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Fax | 724-838-7717
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Provider Business Mailing Address
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Address Line | 426 PELLIS RD
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City | GREENSBURG
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State | PA
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Zip | 15601-4574
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Country | US
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Telephone | 724-838-0090
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Fax | 724-838-7717
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Authorized Official
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Title or Position | MANAGER
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Name | KARUNA SREE MANDAVA
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Credential | M.D
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Telephone | 724-838-0090
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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 | MD072721L
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License Number State | PA
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