Provider Demographics
NPI:1316136583
Name:BETHESDA NEUROLOGY, LLC
Entity type:Organization
Organization Name:BETHESDA NEUROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-540-2700
Mailing Address - Street 1:3202 TOWER OAKS BLVD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:N BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4219
Mailing Address - Country:US
Mailing Address - Phone:301-540-2700
Mailing Address - Fax:866-328-4322
Practice Address - Street 1:3202 TOWER OAKS BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:N BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-4219
Practice Address - Country:US
Practice Address - Phone:301-540-2700
Practice Address - Fax:866-328-4322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00524472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F39650Medicare UPIN
G01640Medicare PIN