Lake Neurology Clinic, P.a.

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME76490 Issued in FL

Legal business name

LAKE NEUROLOGY CLINIC, P.A.

Practice address

608 S 9TH Street
Ste a
Leesburg, FL 34748

Phone

(352) 360-1122

Fax

(352) 360-1123

NPI assigned

Nov 15, 2006

Organization subpart

No

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

Authorized official

Name

Marilyn C Glover

Title

Office Manager

Phone

(352) 360-1122

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marlyn A Lake, MD

  • Neurology Physician
  • Macon, GA
  • NPI 1952405318
  NPD

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267747200000",
    "number": "1700958600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 490123",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347490123",
            "telephone_number": "352-360-1122",
            "fax_number": "352-360-1123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 S 9TH STREET",
            "address_2": "STE A",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "34748",
            "telephone_number": "352-360-1122",
            "fax_number": "352-360-1123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE NEUROLOGY CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2010-03-05",
        "status": "A",
        "authorized_official_last_name": "GLOVER",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "352-360-1122"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME76490",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "130025175",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "44751",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "257303200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lake Internal Medicine PA
• Lake Medical Billing Services Inc
• Lake Medical Imaging and Breast Center at the Villages LLC
• Lake Neurodiversity, LLC
• Lake Neurodiversity, LLC
• Lake Pulmonary & Sleep Disorders Clinic P.a.
• Lake Square Chiropractic, P.a.
• Lake Surgery & Endoscopy Center LTD
• Lake Surgical Clinic PA
• Lake Urology Clinic

• Specialist in Leesburg, FL
• Providers in Leesburg, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2010; 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.