| C H Neurology Foundation Inc | |
|
300 Longwood Ave Fegan 11 Boston MA 02115-5724 | |
| (617) 355-6388 | |
| (617) 730-0284 |
| Full Name | C H Neurology Foundation Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 300 Longwood Ave, Boston, Massachusetts |
| Authorized Official Name and Position | Frank Davis (DEPT ADMINISTRATOR) |
| Authorized Official Contact | 6173556374 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| C H Neurology Foundation Inc 300 Longwood Ave Fegan 11 Boston MA 02115-5724 Ph: (617) 355-6388 | C H Neurology Foundation Inc 300 Longwood Ave Fegan 11 Boston MA 02115-5724 Ph: (617) 355-6388 |
| NPI Number | 1063432417 |
|---|---|
| Provider Enumeration Date | 07/20/2006 |
| Last Update Date | 05/23/2023 |
| Certification Date | 05/23/2023 |
| Medicare PECOS PAC ID | 5496744195 |
|---|---|
| Medicare Enrollment ID | O20040508000019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063432417 | NPI | - | NPPES |
| 9749802 | Medicaid | MA |
| Provider Name | Masanori Takeoka |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1780602227 PECOS PAC ID: 4385638527 Enrollment ID: I20040412000957 |
| Provider Name | Christine Mrakotsky |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1588715700 PECOS PAC ID: 9739170747 Enrollment ID: I20040519000938 |
| Provider Name | Katrina M. Boyer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1578618005 PECOS PAC ID: 7416934708 Enrollment ID: I20040706000252 |
| Provider Name | Lara Morse |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1043328479 PECOS PAC ID: 4284614017 Enrollment ID: I20040722000780 |
| Provider Name | Nutan Sharma |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1700867975 PECOS PAC ID: 5193799773 Enrollment ID: I20040820000098 |
| Provider Name | Lauren Lafortune |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1295718625 PECOS PAC ID: 6204800873 Enrollment ID: I20040820000718 |
| Provider Name | Nicole J Ullrich |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1912927377 PECOS PAC ID: 9830165141 Enrollment ID: I20040908001003 |
| Provider Name | Mark H Libenson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1174541932 PECOS PAC ID: 7214987361 Enrollment ID: I20050126000546 |
| Provider Name | Anna Minster |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1124046982 PECOS PAC ID: 6608829668 Enrollment ID: I20050302000265 |
| Provider Name | Janet S Soul |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1346268885 PECOS PAC ID: 4789638891 Enrollment ID: I20050310000570 |
| Provider Name | Mustafa Sahin |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1487671269 PECOS PAC ID: 7012961121 Enrollment ID: I20050310000606 |
| Provider Name | David L Coulter |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1306871900 PECOS PAC ID: 6002860129 Enrollment ID: I20050310000694 |
| Provider Name | Irina Anselm |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1396790788 PECOS PAC ID: 4486608510 Enrollment ID: I20050310000781 |
| Provider Name | Eugene J Roe |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1780600700 PECOS PAC ID: 7810943552 Enrollment ID: I20050325000546 |
| Provider Name | Michael J Rivkin |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1407871874 PECOS PAC ID: 0749236321 Enrollment ID: I20050328000033 |
| Provider Name | Scott L Pomeroy |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1235158668 PECOS PAC ID: 1658327259 Enrollment ID: I20050328000221 |
| Provider Name | David K Urion |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1497778195 PECOS PAC ID: 6709832306 Enrollment ID: I20050328000256 |
| Provider Name | Annmarie R Bergin |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1427081280 PECOS PAC ID: 0244286854 Enrollment ID: I20050328000323 |
| Provider Name | Basil T Darras |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1538191309 PECOS PAC ID: 3173579604 Enrollment ID: I20050328000474 |
| Provider Name | Paul A Rosenberg |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1790705648 PECOS PAC ID: 1052367539 Enrollment ID: I20050328000955 |
| Provider Name | Peter C Raffalli |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1194744870 PECOS PAC ID: 9931098118 Enrollment ID: I20050419000701 |
| Provider Name | Michael B Robbins |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1760479091 PECOS PAC ID: 2567351711 Enrollment ID: I20050715000547 |
| Provider Name | Annapurna Poduri |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1275568487 PECOS PAC ID: 8527095900 Enrollment ID: I20050719000109 |
| Provider Name | Roula Choueiri |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1376644815 PECOS PAC ID: 9537188677 Enrollment ID: I20051117000296 |
| Provider Name | Alexander Rotenberg |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1154348043 PECOS PAC ID: 8022011014 Enrollment ID: I20060811000277 |
| Provider Name | Lora M Pixley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790818367 PECOS PAC ID: 0840397907 Enrollment ID: I20070524000183 |
| Provider Name | Maitreyi Mazumdar |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1003970328 PECOS PAC ID: 5395836225 Enrollment ID: I20070807000788 |
| Provider Name | Karameh Y Kuemmerle |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1427004902 PECOS PAC ID: 1658387824 Enrollment ID: I20070822000606 |
| Provider Name | Michel Fayad |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1881688901 PECOS PAC ID: 6305927955 Enrollment ID: I20080122000034 |
| Provider Name | Robert R Wolff |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1073600037 PECOS PAC ID: 7719066646 Enrollment ID: I20080505000269 |
| Provider Name | Mark P Gorman |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1881636017 PECOS PAC ID: 6002981917 Enrollment ID: I20080812000324 |
| Provider Name | Pradeep Dinakar |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1073650057 PECOS PAC ID: 7214082775 Enrollment ID: I20090904000246 |
| Provider Name | Tobias Loddenkemper |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1922272350 PECOS PAC ID: 7618023326 Enrollment ID: I20090922000565 |
| Provider Name | Catherine A Chapman |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1124044920 PECOS PAC ID: 1557408069 Enrollment ID: I20091102000167 |
| Provider Name | Elizabeth C. Engle |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1972521276 PECOS PAC ID: 0840320214 Enrollment ID: I20100610000919 |
| Provider Name | Alex M Taylor |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174855167 PECOS PAC ID: 7911038484 Enrollment ID: I20100627000027 |
| Provider Name | Kiran P. Maski |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1598945024 PECOS PAC ID: 8123151347 Enrollment ID: I20100809000323 |
| Provider Name | Jayshiri Srinsvan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1568563245 PECOS PAC ID: 8527182302 Enrollment ID: I20100831000546 |
| Provider Name | Margaret L. Marlatt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316192362 PECOS PAC ID: 4183749500 Enrollment ID: I20100908001026 |
| Provider Name | Regina M Laine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700064433 PECOS PAC ID: 9638294614 Enrollment ID: I20100914000904 |
| Provider Name | Clemente Vega |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1033431317 PECOS PAC ID: 3476679747 Enrollment ID: I20100923000811 |
| Provider Name | Jonathan O. Lipton |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1134305071 PECOS PAC ID: 6204029457 Enrollment ID: I20101020000221 |
| Provider Name | Lois O Condie |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972664126 PECOS PAC ID: 6002009826 Enrollment ID: I20101025000573 |
| Provider Name | Richard C Antonelli |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1275505786 PECOS PAC ID: 2567493661 Enrollment ID: I20101215000673 |
| Provider Name | Chellamani Harini |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1023042785 PECOS PAC ID: 9931106523 Enrollment ID: I20110316000333 |
| Provider Name | Sarah J Spence |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1497862163 PECOS PAC ID: 1052392180 Enrollment ID: I20110316000448 |
| Provider Name | William M Mitchell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053348227 PECOS PAC ID: 7416139134 Enrollment ID: I20110316000581 |
| Provider Name | Elizabeth A Barkoudah |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1063614352 PECOS PAC ID: 5092986687 Enrollment ID: I20110912000049 |
| Provider Name | Karen Mary Stannard |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1295901858 PECOS PAC ID: 6204002967 Enrollment ID: I20111229000603 |
| Provider Name | Michal Vytopil |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1134337249 PECOS PAC ID: 0840367967 Enrollment ID: I20120126000710 |
| Provider Name | Patricia H Lee |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1275840456 PECOS PAC ID: 2961658620 Enrollment ID: I20120813000063 |
| Provider Name | Karen L Kerman |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1518911767 PECOS PAC ID: 3173626504 Enrollment ID: I20120823000075 |
| Provider Name | Jeffrey B Bolton |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1457541625 PECOS PAC ID: 8527216746 Enrollment ID: I20120913000298 |
| Provider Name | Jurriaan M Peters |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1417135385 PECOS PAC ID: 3870745367 Enrollment ID: I20121207000396 |
| Provider Name | Kerri L Larovere |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1336357615 PECOS PAC ID: 4486813524 Enrollment ID: I20130301000397 |
| Provider Name | Heather E Olson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1013174804 PECOS PAC ID: 3476796194 Enrollment ID: I20130828000733 |
| Provider Name | Leslie A Benson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1194851832 PECOS PAC ID: 3971761735 Enrollment ID: I20130828000816 |
| Provider Name | Anna L Pinto |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1588822787 PECOS PAC ID: 6305099532 Enrollment ID: I20131203001850 |
| Provider Name | Ferne A Pinard |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1215379193 PECOS PAC ID: 7810124856 Enrollment ID: I20131218000691 |
| Provider Name | Rebecca M Stevens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639501331 PECOS PAC ID: 4284863879 Enrollment ID: I20140130000975 |
| Provider Name | Phillip L Pearl |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1902983257 PECOS PAC ID: 6406042761 Enrollment ID: I20140401000347 |
| Provider Name | Laura L Lehman |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1720295686 PECOS PAC ID: 6204068372 Enrollment ID: I20140404000597 |
| Provider Name | Kinga K Tomczak |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1891962171 PECOS PAC ID: 1052544590 Enrollment ID: I20140507001189 |
| Provider Name | Caitlin K Rollins |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1265639389 PECOS PAC ID: 1658596093 Enrollment ID: I20140627000860 |
| Provider Name | Arnold Joseph Sansevere |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629217641 PECOS PAC ID: 3779708474 Enrollment ID: I20140715000034 |
| Provider Name | Nicole T Baumer |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1427243237 PECOS PAC ID: 4880810431 Enrollment ID: I20140717001138 |
| Provider Name | Lucia C Bastianelli |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1447688437 PECOS PAC ID: 5991921025 Enrollment ID: I20140728000524 |
| Provider Name | Partha S Ghosh |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1235303678 PECOS PAC ID: 0941456339 Enrollment ID: I20140806002316 |
| Provider Name | Jennifer C Hanowell |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1164507539 PECOS PAC ID: 8628248911 Enrollment ID: I20141001002350 |
| Provider Name | April R Levin |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1295901619 PECOS PAC ID: 4587884184 Enrollment ID: I20141002001144 |
| Provider Name | Judith A Owens |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1902846678 PECOS PAC ID: 2365465861 Enrollment ID: I20150428000051 |
| Provider Name | Rasha Srouji |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437547338 PECOS PAC ID: 1658685839 Enrollment ID: I20150731015834 |
| Provider Name | Christopher M Elitt |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1447410311 PECOS PAC ID: 9830408178 Enrollment ID: I20151027002074 |
| Provider Name | Carrie P. Peek |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1356560155 PECOS PAC ID: 6103983747 Enrollment ID: I20151119001273 |
| Provider Name | Archana A Patel |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1679701486 PECOS PAC ID: 4183885247 Enrollment ID: I20151121000205 |
| Provider Name | Jocelyn A Pedrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558737445 PECOS PAC ID: 0941500961 Enrollment ID: I20151124000882 |
| Provider Name | Eric Zhou |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1669876074 PECOS PAC ID: 9638471477 Enrollment ID: I20160111001137 |
| Provider Name | Candice E Marti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174771752 PECOS PAC ID: 8022312479 Enrollment ID: I20160205001116 |
| Provider Name | Courtney T Lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215369228 PECOS PAC ID: 8729385943 Enrollment ID: I20160401000517 |
| Provider Name | Karen A Spencer |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1295994846 PECOS PAC ID: 2466679196 Enrollment ID: I20160628002499 |
| Provider Name | Claudio Melo De Gusmao |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1891927125 PECOS PAC ID: 6901024314 Enrollment ID: I20160728000375 |
| Provider Name | Christelle Moufawad El Achkar |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1467696138 PECOS PAC ID: 1850552993 Enrollment ID: I20160815002000 |
| Provider Name | Lance H Rodan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1326480765 PECOS PAC ID: 5698060820 Enrollment ID: I20160826000133 |
| Provider Name | Tatiana K Filina |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1073820247 PECOS PAC ID: 9032341029 Enrollment ID: I20160912002085 |
| Provider Name | David N Lieberman |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1457397770 PECOS PAC ID: 5092722934 Enrollment ID: I20161025001461 |
| Provider Name | Christopher J Yuskaitis |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1619266889 PECOS PAC ID: 0446531917 Enrollment ID: I20161222000437 |
| Provider Name | Molly M Tracy |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1124210968 PECOS PAC ID: 6204963358 Enrollment ID: I20170322000297 |
| Provider Name | Peter E Davis |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1487928735 PECOS PAC ID: 4981859634 Enrollment ID: I20170623002380 |
| Provider Name | Miya E Bernson-leung |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1477877033 PECOS PAC ID: 2860646049 Enrollment ID: I20170627002781 |
| Provider Name | Paige E Marshall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578083523 PECOS PAC ID: 3274899794 Enrollment ID: I20171115002706 |
| Provider Name | Siddharth Srivastava |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1255658209 PECOS PAC ID: 3274784830 Enrollment ID: I20171117001989 |
| Provider Name | Elizabeth A Maloney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265890289 PECOS PAC ID: 2163701368 Enrollment ID: I20171213001361 |
| Provider Name | Kate S Mysak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801262050 PECOS PAC ID: 6608184684 Enrollment ID: I20180427001699 |
| Provider Name | Alexander L Cohen |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1316232705 PECOS PAC ID: 7911153929 Enrollment ID: I20180524000566 |
| Provider Name | Sara G. Delvecchio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033341789 PECOS PAC ID: 3779624630 Enrollment ID: I20181027000097 |
| Provider Name | Melissa Tsuboyama |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1134495435 PECOS PAC ID: 8123352903 Enrollment ID: I20190627002337 |
| Provider Name | Viviana Benitez |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1922307172 PECOS PAC ID: 5395018345 Enrollment ID: I20190730003371 |
| Provider Name | Hoa Lam Schneider |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528615721 PECOS PAC ID: 2860824497 Enrollment ID: I20191119002723 |
| Provider Name | Matthew E Fasano |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1720634587 PECOS PAC ID: 7911339551 Enrollment ID: I20191119002914 |
| Provider Name | Heather Lee Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043735905 PECOS PAC ID: 7113352519 Enrollment ID: I20200113001825 |
| Provider Name | Andrea Sacks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205475571 PECOS PAC ID: 7719316207 Enrollment ID: I20200403002758 |
| Provider Name | Gail M Grodzinsky |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1396895769 PECOS PAC ID: 0840620613 Enrollment ID: I20200417002333 |
| Provider Name | Katie M Fleischman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639421498 PECOS PAC ID: 1355660523 Enrollment ID: I20200508000553 |
| Provider Name | Coral Marie Stredny |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1801138201 PECOS PAC ID: 5092146811 Enrollment ID: I20200512001485 |
| Provider Name | Joshua T August |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1366860173 PECOS PAC ID: 4789802646 Enrollment ID: I20200526002808 |
| Provider Name | Robert Clinton Stowe |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1386087807 PECOS PAC ID: 1254756604 Enrollment ID: I20200803001653 |
| Provider Name | Kellen Diamond Winden |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1336414531 PECOS PAC ID: 3072938372 Enrollment ID: I20200804001133 |
| Provider Name | Alyssa S Ailion |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750905428 PECOS PAC ID: 9032529227 Enrollment ID: I20201028002896 |
| Provider Name | Hilary Segar Garber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558976845 PECOS PAC ID: 8921419011 Enrollment ID: I20201120001218 |
| Provider Name | Hillary B Horte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356853881 PECOS PAC ID: 9133531734 Enrollment ID: I20201223000237 |
| Provider Name | Margaret M Wilson Murphy |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1619247608 PECOS PAC ID: 4486069317 Enrollment ID: I20210226000836 |
| Provider Name | Ann Marie Paris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124429535 PECOS PAC ID: 9931515707 Enrollment ID: I20210303001748 |
| Provider Name | Maile A Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649356668 PECOS PAC ID: 2163838509 Enrollment ID: I20210309001658 |
| Provider Name | Stephanie Lynn Donatelli |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1487049680 PECOS PAC ID: 6507266459 Enrollment ID: I20210614003028 |
| Provider Name | Diane Shao |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1497149900 PECOS PAC ID: 9234528928 Enrollment ID: I20211118001660 |
| Provider Name | Hannah Shapiro |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1811359045 PECOS PAC ID: 4385035930 Enrollment ID: I20211215002524 |
| Provider Name | Pamela Schardin Rogers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205117330 PECOS PAC ID: 2163817768 Enrollment ID: I20220317001757 |
| Provider Name | Maria Demeo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629592035 PECOS PAC ID: 5991192692 Enrollment ID: I20220427002985 |
| Provider Name | Kimberly Wiltrout |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1073994216 PECOS PAC ID: 2466875331 Enrollment ID: I20220513000627 |
| Provider Name | William I Hong |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1154716850 PECOS PAC ID: 1951789189 Enrollment ID: I20220531002442 |
| Provider Name | Jessica Klein |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1619201472 PECOS PAC ID: 3779732631 Enrollment ID: I20220607000488 |
| Provider Name | Catherine Lourdes Salussolia |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1659790384 PECOS PAC ID: 3971982513 Enrollment ID: I20220628001398 |
| Provider Name | Leslie H Hayes |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629422589 PECOS PAC ID: 4789064940 Enrollment ID: I20220706000110 |
| Provider Name | Darius Ebrahimi Fakhari |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1386006997 PECOS PAC ID: 7214318625 Enrollment ID: I20220718000106 |
| Provider Name | Agnieszka Kielian |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1619361672 PECOS PAC ID: 9830499912 Enrollment ID: I20220721000899 |
| Provider Name | Michelle Codner |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1326436965 PECOS PAC ID: 7719354794 Enrollment ID: I20221103001983 |
| Provider Name | Chelsea Spindel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336549187 PECOS PAC ID: 1759604424 Enrollment ID: I20230222001310 |
| Provider Name | Andrea Alfani Raney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720704166 PECOS PAC ID: 1355714692 Enrollment ID: I20230307001228 |
| Provider Name | Julia Smalley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023717469 PECOS PAC ID: 7719342161 Enrollment ID: I20230508002222 |
| Provider Name | Milena M Andzelm |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1073975579 PECOS PAC ID: 7618333949 Enrollment ID: I20230511002503 |
| Provider Name | Michelle Y Chiu |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1740854967 PECOS PAC ID: 0648636175 Enrollment ID: I20230525000862 |
| Provider Name | John Mclaren |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1932637709 PECOS PAC ID: 5496029456 Enrollment ID: I20230621000554 |
| Provider Name | Sara K Trowbridge |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1679967590 PECOS PAC ID: 5890156319 Enrollment ID: I20230801001192 |
| Provider Name | Katelyn Jeanne Laracy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235400102 PECOS PAC ID: 0840653382 Enrollment ID: I20230830003486 |
| Provider Name | Tuba R Khan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1669868550 PECOS PAC ID: 4789088436 Enrollment ID: I20240111001374 |
| Provider Name | Alisa Mo |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1275987638 PECOS PAC ID: 0446696991 Enrollment ID: I20240307000786 |
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