MEDICARE: RIVERSIDE NEUROLOGY ASSOCIATES 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	2084N0400X	Neurology Physician		MD

General Provider Information

NPI Number	:	1245710631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE NEUROLOGY ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	560 RIVERSIDE DR STE B204
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21801-4703
Country	:	US
Telephone Number	:	410-546-5722
Fax Number	:	410-546-5851

Provider Business Practice Location Address
First Line	:	560 RIVERSIDE DR STE B204
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21801-4703
Country	:	US
Telephone Number	:	410-546-5722
Fax Number	:	410-546-5851

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DANIAL MC DONALD
Credential	:
Telephone Number	:	410-456-5722

Provider Enumeration Date	:	08/15/2018
Last Update Date	:	08/15/2018

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