MEDICARE: MECKLENBURG NEUROLOGICAL ASSOCIATES, PA

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

General Provider Information

NPI Number	:	1952469710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MECKLENBURG NEUROLOGICAL ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	1900 SCOTT AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-6046
Country	:	US
Telephone Number	:	704-334-7311
Fax Number	:	704-335-9790

Provider Business Practice Location Address
First Line	:	1900 SCOTT AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-6046
Country	:	US
Telephone Number	:	704-334-7311
Fax Number	:	704-335-9790

Authorized Official
Title or Position	:	ADMIN. ASST
Name	:	MS. SHERRY H BUTTERY
Credential	:
Telephone Number	:	704-334-7311

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/14/2011

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