| C C Neurology Llc | |
|
11637 Terrace Dr Ste 100 Waldorf MD 20602-3707 | |
| (301) 870-7287 | |
| Not Available |
| Full Name | C C Neurology Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 11637 Terrace Dr Ste 100, Waldorf, Maryland |
| Authorized Official Name and Position | Roche Watson (PRACTICE OWNER) |
| Authorized Official Contact | 3018707287 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| C C Neurology Llc 11637 Terrace Dr Ste 100 Waldorf MD 20602-3707 Ph: () - | C C Neurology Llc 11637 Terrace Dr Ste 100 Waldorf MD 20602-3707 Ph: (301) 870-7287 |
| NPI Number | 1750158374 |
|---|---|
| Provider Enumeration Date | 12/04/2023 |
| Last Update Date | 12/04/2023 |
| Certification Date | 12/04/2023 |
| Medicare PECOS PAC ID | 4880047646 |
|---|---|
| Medicare Enrollment ID | O20240129000162 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750158374 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Michael K Greenberg |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1932192150 PECOS PAC ID: 4183536311 Enrollment ID: I20031105000174 |
| Provider Name | Roche M Watson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639522659 PECOS PAC ID: 8628352283 Enrollment ID: I20170227000204 |
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