NPIMap

Organization Active NPI

Center for Brain and Neurocare LLC

  • Neurology Physician
  • Fulton, MD
National Provider Identifier
1013392687
Registry record updated Jul 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
D0047119 Issued in MD
Legal business name
CENTER FOR BRAIN AND NEUROCARE LLC
Practice address
7625 Maple Lawn Blvd
Suite 260
Fulton, MD 20759-2565
Phone
(301) 490-3700
NPI assigned
Jul 24, 2015
Last updated
Jul 24, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Vajira Gunawardane, M.D.NPI 1447294269
Title
Owner
Phone
(703) 994-6655

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X D0047120 MD
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X D0047119 MD Primary

Addresses

Primary practice location

7625 Maple Lawn Blvd
Suite 260
Fulton, MD 20759-2565

Mailing address

7625 Maple Lawn Blvd
Suite 260
Fulton, MD 20759-2565
Phone (301) 490-3700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20151014001972 MD Part B Supplier - Clinic/Group Practice 9335458371 Receives reassigned benefits from 6 practitioners
Practice locations: Fulton, MD
O20190529001954 MD DME Supplier - Physician - General Practice 9335458371 Practice locations: Fulton, MD

National Provider Directory

National Provider Directory
Tax ID family
Center for Brain and Neurocare LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1437696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437696000000",
    "number": "1013392687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7625 MAPLE LAWN BLVD",
            "address_2": "SUITE 260",
            "city": "FULTON",
            "state": "MD",
            "postal_code": "207592565",
            "telephone_number": "301-490-3700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7625 MAPLE LAWN BLVD",
            "address_2": "SUITE 260",
            "city": "FULTON",
            "state": "MD",
            "postal_code": "207592565",
            "telephone_number": "301-490-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR BRAIN AND NEUROCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-24",
        "last_updated": "2015-07-24",
        "status": "A",
        "authorized_official_last_name": "GUNAWARDANE",
        "authorized_official_first_name": "VAJIRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-994-6655",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "MD",
            "license": "D0047120",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MD",
            "license": "D0047119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fulton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.