| Neuro Care Of Virginia Pc | |
|
4720 Puddledock Rd Suite 100 Prince George VA 23875-1237 | |
| (804) 452-4546 | |
| (804) 452-4549 |
| Full Name | Neuro Care Of Virginia Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4720 Puddledock Rd, Prince George, Virginia |
| Authorized Official Name and Position | Mubashir A Khan (PRESIDENT) |
| Authorized Official Contact | 8044524546 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neuro Care Of Virginia Pc 4720 Puddledock Rd Suite 100 Prince George VA 23875-1237 Ph: (804) 452-4546 | Neuro Care Of Virginia Pc 4720 Puddledock Rd Suite 100 Prince George VA 23875-1237 Ph: (804) 452-4546 |
| NPI Number | 1124087812 |
|---|---|
| Provider Enumeration Date | 03/21/2006 |
| Last Update Date | 08/26/2015 |
| Medicare PECOS PAC ID | 5991801987 |
|---|---|
| Medicare Enrollment ID | O20070508000622 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124087812 | NPI | - | NPPES |
| 1710154786 | Other | VA | DR. BU NPI |
| C08332 | Other | MEDICARE GROUP NUMBER | |
| 1023087368 | Other | VA | DR. KHAN NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Mubashir A Khan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1023087368 PECOS PAC ID: 9234152299 Enrollment ID: I20060105000533 |
| Provider Name | Bushra Khan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1861747289 PECOS PAC ID: 3678892981 Enrollment ID: I20161018000391 |
| Provider Name | Ludna Maiden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932877255 PECOS PAC ID: 9032596382 Enrollment ID: I20220506001651 |
| Provider Name | Jaclyn Amelia Crowley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437939121 PECOS PAC ID: 0446698443 Enrollment ID: I20240410001762 |
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