Provider Demographics
NPI:1861966434
Name:DAYTON NEUROLOGIC ASSOCIATES LLC
Entity type:Organization
Organization Name:DAYTON NEUROLOGIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:VERDON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-440-5953
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-0203
Mailing Address - Country:US
Mailing Address - Phone:937-797-3137
Mailing Address - Fax:937-972-0445
Practice Address - Street 1:8805 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1333
Practice Address - Country:US
Practice Address - Phone:937-797-3137
Practice Address - Fax:937-972-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0331658Medicaid
OHH698970OtherMEDICARE PTAN
OH7755330001OtherMEDICARE DME PTAN
OHDZ0946OtherRRMEDICARE PTAN