Provider Demographics
NPI:1548049026
Name:NEUROGLEE CARE PLLC
Entity type:Organization
Organization Name:NEUROGLEE CARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-313-8000
Mailing Address - Street 1:101 ARCH ST FL 8
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-7500
Mailing Address - Country:US
Mailing Address - Phone:888-411-7686
Mailing Address - Fax:857-557-5778
Practice Address - Street 1:615 SAINT GEORGE SQUARE CT STE 300
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1368
Practice Address - Country:US
Practice Address - Phone:888-411-7686
Practice Address - Fax:857-557-5778
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUROGLEE CARE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-25
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty