Provider Demographics
NPI:1043346471
Name:NEUROLOGY MICROPRACTICE, P.C.
Entity type:Organization
Organization Name:NEUROLOGY MICROPRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:LANGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-775-7778
Mailing Address - Street 1:PO BOX 912
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05702-0912
Mailing Address - Country:US
Mailing Address - Phone:802-775-7778
Mailing Address - Fax:802-775-7775
Practice Address - Street 1:73 CENTER ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4046
Practice Address - Country:US
Practice Address - Phone:802-775-7778
Practice Address - Fax:802-775-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-00112712084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1013330Medicaid