Provider Demographics
NPI:1386736171
Name:NEUROLOGIC ASSOCIATES OF LAKE COUNTY, INC.
Entity type:Organization
Organization Name:NEUROLOGIC ASSOCIATES OF LAKE COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:ARALINE
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-639-6550
Mailing Address - Street 1:7879 AUBURN RD
Mailing Address - Street 2:1-D
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9178
Mailing Address - Country:US
Mailing Address - Phone:440-639-6550
Mailing Address - Fax:440-639-6553
Practice Address - Street 1:7879 AUBURN RD
Practice Address - Street 2:1-D
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-9178
Practice Address - Country:US
Practice Address - Phone:440-639-6550
Practice Address - Fax:440-639-6553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045475L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000133226OtherANTHEM
OH0626022Medicaid
OH186369648021OtherMEDICAL MUTUAL
OH18636948017OtherMEDICAL MUTUAL
OH186369648020OtherMEDICAL MUTUAL
OH=========OtherTAX ID
OH186369648021OtherMEDICAL MUTUAL
OH186369648020OtherMEDICAL MUTUAL
OH18636948017OtherMEDICAL MUTUAL
9928495Medicare ID - Type Unspecified