Provider Demographics
NPI:1447552799
Name:NEURO MEDIC
Entity type:Organization
Organization Name:NEURO MEDIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-614-5576
Mailing Address - Street 1:7 SAINT PAUL ST
Mailing Address - Street 2:STE 1660
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-1626
Mailing Address - Country:US
Mailing Address - Phone:484-614-5576
Mailing Address - Fax:610-903-4281
Practice Address - Street 1:7 SAINT PAUL ST
Practice Address - Street 2:STE 1660
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-1626
Practice Address - Country:US
Practice Address - Phone:484-614-5576
Practice Address - Fax:610-903-4281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty