| Fremont Neurology Medical Associates Inc A Prof Medical Corp | |
|
722 Mowry Ave Fremont CA 94536-4115 | |
| (510) 713-3390 | |
| (510) 713-3393 |
| Full Name | Fremont Neurology Medical Associates Inc A Prof Medical Corp |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 722 Mowry Ave, Fremont, California |
| Authorized Official Name and Position | Prabhjot Singh Khalsa (PRESIDENT) |
| Authorized Official Contact | 5107133390 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fremont Neurology Medical Associates Inc A Prof Medical Corp 722 Mowry Ave Fremont CA 94536-4115 Ph: (510) 713-3390 | Fremont Neurology Medical Associates Inc A Prof Medical Corp 722 Mowry Ave Fremont CA 94536-4115 Ph: (510) 713-3390 |
| NPI Number | 1144280660 |
|---|---|
| Provider Enumeration Date | 03/27/2006 |
| Last Update Date | 12/11/2007 |
| Medicare PECOS PAC ID | 6608957220 |
|---|---|
| Medicare Enrollment ID | O20080121000203 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144280660 | NPI | - | NPPES |
| 00G662631 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | G66263 (California) | Primary |
| 2084N0600X | Psychiatry & Neurology - Clinical Neurophysiology | G66263 (California) | Secondary |
| Provider Name | Prabhjot S Khalsa |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1134189590 PECOS PAC ID: 7416038039 Enrollment ID: I20080121000213 |
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