Provider Demographics
NPI:1386788446
Name:CNMRI PA
Entity type:Organization
Organization Name:CNMRI PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNMRI AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-346-2491
Mailing Address - Street 1:1095 S BRADFORD ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4141
Mailing Address - Country:US
Mailing Address - Phone:302-678-8100
Mailing Address - Fax:
Practice Address - Street 1:111 NEUROLOGY WAY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19901
Practice Address - Country:US
Practice Address - Phone:302-422-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000396902Medicaid
DECE715408Medicare ID - Type UnspecifiedCNMRI GROUP NUMBER