Provider Demographics
NPI:1194983569
Name:NEUROLOGY CENTER OF VIRGINIA, LLC
Entity type:Organization
Organization Name:NEUROLOGY CENTER OF VIRGINIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERNAN
Authorized Official - Middle Name:TAPIA
Authorized Official - Last Name:GATUSLAO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:804-302-4400
Mailing Address - Street 1:16718 KIPPER TURN
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-2222
Mailing Address - Country:US
Mailing Address - Phone:804-302-4400
Mailing Address - Fax:
Practice Address - Street 1:2436 COLONY CROSSING PL
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4281
Practice Address - Country:US
Practice Address - Phone:804-302-4400
Practice Address - Fax:804-601-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-01
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH67083Medicare UPIN