MID ATLANTIC NEUROLOGY & SLEEP MEDICINE, P.A. (NPI# 1043545056) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1043545056 |
Entity Type | Organization |
Organization Name | MID ATLANTIC NEUROLOGY & SLEEP MEDICINE, P.A. |
Practice Address |
34 Office Park Dr Ste 100 Jacksonville NC 28546-3221 |
Practice Telephone | 9103533624 |
Practice Fax Number | 9103530550 |
Enumeration Date | 2009-10-08 |
Last Update Date | 2017-06-12 |
Authorized Official Name | DR. KHALED F JREISAT (PRESIDENT) |
Authorized Official Telephone | 9103533624 |
Authorized Official Credential | MD |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 207RS0012X |
Internal Medicine Specialization: Sleep Medicine |
Allopathic & Osteopathic Physicians | ||
N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians | ||
Y | 2084N0402X |
Psychiatry & Neurology Specialization: Neurology with Special Qualifications in Child Neurology |
27377 | NC | Allopathic & Osteopathic Physicians |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1669708665 | Mid Atlantic Neurology & Sleep Medicine, P.a. | Internal Medicine | 227 Memorial Dr, Jacksonville, NC 28546-6333 | 2009-10-26 |
Street Address |
34 OFFICE PARK DR STE 100 |
City | JACKSONVILLE |
State | NC |
Zip Code | 28546-3221 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1083079701 | Terra Lynn Kamp | Nurse Practitioner | 34 Office Park Dr Ste 100, Jacksonville, NC 28546-3221 | 2015-12-22 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1316578388 | Judylyn Hobson | Registered Nurse | Pride In North Carolina, LLC, 3886 Henderson Dr, Jacksonville, NC 28546 | 2020-01-29 |
1427694637 | Aaron Patrick Bettcher | Military Health Care Provider | 3rd Mrb Loop Rd, Camp Lejeune, NC 28546 | 2019-11-22 |
1962044289 | Levi Scott Marshall | Military Health Care Provider | Everett Creek Road, Building 612, Camp Lejeune, NC 28546 | 2019-10-09 |
1649826652 | Nicholas Otazo | Military Health Care Provider | 3rd Mrb 20073, Camp Lejeune, NC 28546 | 2019-08-15 |
1417519570 | Publix North Carolina, Lp | Durable Medical Equipment & Medical Supplies | 2001 Marlin Drive Unit 100, Jacksonville, NC 28546 | 2019-06-28 |
1023500212 | Josip Ninrodriguez | Military Health Care Provider | 3d Marine Raider Battaliom, Camp Lejeune, NC 28546 | 2018-06-04 |
1639661192 | Kenneth Lee Russell | Military Health Care Provider | 3d Marine Raider Battalion, Camp Lejeune, NC 28546 | 2018-05-31 |
1346730173 | Coastal Foot Center, LLC | Clinic/Center | 29 Office Park Dr Ste B, Jacksonville, NC 28546 | 2018-05-17 |
1578080271 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 380 Western Blvd, Jacksonville, NC 28546 | 2017-08-24 |
1144757493 | Darin Lee Peterson | Specialist/Technologist | G644 Camp Geiger, School of Infantry-east, Jacksonville, NC 28546 | 2017-05-17 |
Find all providers in zip 28546 |
Taxonomy Code | 2084N0402X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Psychiatry & Neurology |
Specialization | Neurology with Special Qualifications in Child Neurology |
A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence. |
Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1336792829 | Graciela Teresita Gallo | Psychiatry & Neurology | 807 Childrens Way, Jacksonville, FL 32207-8426 | 2019-07-23 |
1720519713 | Chethan Krishna Rao | Psychiatry & Neurology | 841 Prudential Dr, Suite 1130, Jacksonville, FL 32207-8329 | 2017-03-22 |
1407241961 | Dana Shprung | Psychiatry & Neurology | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2015-04-01 |
1225444664 | Jun Ho Kim | Psychiatry & Neurology | 807 Childrens Way, Jacksonville, FL 32207-8426 | 2014-07-07 |
1720401151 | Neuro Care, Pllc | Psychiatry & Neurology | 3050 Henderson Dr, Jacksonville, NC 28540 | 2014-01-21 |
1992962773 | Erick Viorritto | Psychiatry & Neurology | 807 Childrens Way, Jacksonville, FL 32207-8426 | 2008-05-20 |
1861682940 | Rubina Y Bakerywala | Psychiatry & Neurology | 807 Childrens Way, Provider Enrollment Department, Jacksonville, FL 32207-8426 | 2007-07-26 |
1699786129 | David N. Hammond | Psychiatry & Neurology | 807 Childrens Way, Jacksonville, FL 32207-8426 | 2006-08-10 |
1427069947 | Harry S. Abram Jr. | Psychiatry & Neurology | 807 Childrens Way, Jacksonville, FL 32207-8426 | 2006-08-10 |
1790706711 | Carmela Lydia Tardo | Psychiatry & Neurology | 6271 Saint Augustine Rd, Ufjp Developmental Pediatrics, Jacksonville, FL 32217-2523 | 2006-07-23 |
Find all providers in JACKSONVILLE |
City | JACKSONVILLE |
Zip Code | 28546 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.