Provider Demographics
NPI: | 1528350790 |
---|---|
Name: | NEUROLOGY INSTITUTE |
Entity type: | Organization |
Organization Name: | NEUROLOGY INSTITUTE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MEDICAL DIRECTOR/OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | MAJID |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FOTUHI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 410-494-0191 |
Mailing Address - Street 1: | 1205 YORK RD |
Mailing Address - Street 2: | SUITE 18 |
Mailing Address - City: | LUTHERVILLE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21093-6210 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 410-494-0191 |
Mailing Address - Fax: | 410-494-0259 |
Practice Address - Street 1: | 1205 YORK RD |
Practice Address - Street 2: | SUITE 18 |
Practice Address - City: | LUTHERVILLE |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21093-6210 |
Practice Address - Country: | US |
Practice Address - Phone: | 410-494-0191 |
Practice Address - Fax: | 410-494-0259 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-05-06 |
Last Update Date: | 2011-05-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | 174400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 174400000X | Other Service Providers | Specialist | Group - Single Specialty |