Provider Demographics
NPI:1194978478
Name:DFW NEUROLOGY PLLC
Entity type:Organization
Organization Name:DFW NEUROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAVANYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NAGINENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-292-0088
Mailing Address - Street 1:6800 HARRIS PKWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4240
Mailing Address - Country:US
Mailing Address - Phone:817-292-0088
Mailing Address - Fax:855-285-0906
Practice Address - Street 1:6800 HARRIS PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4240
Practice Address - Country:US
Practice Address - Phone:817-292-0088
Practice Address - Fax:855-285-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM95242084N0400X
2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201059701Medicaid
0A0318Medicare PIN