MEDICARE: NEUROLOGY PA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	1860	DE
2	261QM2500X	Medical Specialty Clinic/Center	MD	PA
3	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1144491754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROLOGY PA LLC

Provider Business Mailing Address
First Line	:	PO BOX 42313
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19101-2313
Country	:	US
Telephone Number	:	610-331-6942
Fax Number	:	215-875-8324

Provider Business Practice Location Address
First Line	:	1500 LOCUST ST
Second Line	:	4406
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-4329
Country	:	US
Telephone Number	:	610-331-6942
Fax Number	:	215-875-8324

Authorized Official
Title or Position	:	MD
Name	:	SHAHLA VAKILI
Credential	:	MD
Telephone Number	:	610-331-6942

Provider Enumeration Date	:	03/23/2008
Last Update Date	:	09/03/2008

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Directions to “NEUROLOGY PA LLC ” Practice Location

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