NPIMap

Organization Active NPI

Virginia Neurospine PC

  • Neurological Surgery Physician
  • Forest, VA
National Provider Identifier
1356893879
Registry record updated Nov 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
0101250836 Issued in VA
Legal business name
VIRGINIA NEUROSPINE PC
Practice address
1019A Vista Park Dr
Forest, VA 24551-4901
Phone
(434) 200-9009
NPI assigned
Nov 1, 2016
Last updated
Nov 1, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2016

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

Authorized official

Name
Dr. Dialntha Ellegala, MD
Title
Owner
Phone
(434) 200-9009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 0101250836 VA Primary

Addresses

Primary practice location

1019A Vista Park Dr
Forest, VA 24551-4901

Mailing address

1019A Vista Park Dr
Forest, VA 24551-4901

National Provider Directory

National Provider Directory

Locations

1019A Vista Park Dr
Forest, VA 24551
Phone (434) 200-9009

Practitioners & affiliated clinicians

Practitioners 2

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": "1477958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477958400000",
    "number": "1356893879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019A VISTA PARK DR",
            "city": "FOREST",
            "state": "VA",
            "postal_code": "245514901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1019A VISTA PARK DR",
            "city": "FOREST",
            "state": "VA",
            "postal_code": "245514901",
            "telephone_number": "434-200-9009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIRGINIA NEUROSPINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-01",
        "last_updated": "2016-11-01",
        "status": "A",
        "authorized_official_last_name": "ELLEGALA",
        "authorized_official_first_name": "DIALNTHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "434-200-9009",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "VA",
            "license": "0101250836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.