MEDICARE: CEP AMERICA - NEUROLOGY PC

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	2084N0400X	Neurology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164109328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEP AMERICA - NEUROLOGY PC

Provider Business Mailing Address
First Line	:	2100 POWELL ST STE 400
Second Line	:
City	:	EMERYVILLE
State	:	CA
Zip	:	94608-1872
Country	:	US
Telephone Number	:	510-350-2600
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 TRINITY WAY
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-1155
Country	:	US
Telephone Number	:	904-450-8120
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT AND SECRETARY
Name	:	DAVID BIRDSALL
Credential	:	MD
Telephone Number	:	510-350-2600

Provider Enumeration Date	:	06/29/2023
Last Update Date	:	06/29/2023

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