Center for Brain and Neurocare LLC
Organization Active NPI Neurology Physician · Fulton, MD
NPI 1013392687 · NPPES record last updated Jul 24, 2015
Key facts
- NPI
- 1013392687
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Neurology Physician 2084N0400X
- License
- D0047119 (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
- Organization subpart
- No
Authorized official
- Name
- Vajira Gunawardane, M.D.
- Title
- Owner
- Phone
- (703) 994-6655
Corporate family (same tax ID) 1
Practitioners 6
-
Ruwani D.P. Gunawardane, M.D.
-
Amber Jobe, CRNP
-
Edward Lee Marshall Jr., DPT, ECS, OCS, R.NCS
-
Sametta Rhoda Sanyaolu, FNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- Tax ID family
- Ctr for Brain and Neurocare
Locations
7625 Maple Lawn Blvd
Ste 260
Fulton, MD 20759
Phone (301) 490-3700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pain Medicine (Anesthesiology) Physician |
207LP2900X | D0047120 | MD | |
| Neurology Physician |
2084N0400X | D0047119 | MD | Yes |
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
Other providers in Fulton, MD
- Capital Women'S Care, L.L.C.
- Samantha Cappuccino
- Miranda Carrillo
- Kweli Keene Carson
- Marie Celano
- Center for Brain and Neurocare LLC
- Centers for Advanced Orthopaedics, LLC
- Centers for Advanced Orthopaedics, LLC
- Centrepointe Counseling
- Centrepointe Counseling, Inc.
All providers in Fulton, MD · Neurology Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.