Organization
NEUROMEDICAL DIAGNOSTIC MEDICAL GROUP
Active
Organization
NEUROMEDICAL DIAGNOSTIC MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PANOS Z MARMARELIS M.D. (PARTNER)
(562) 591-1324
Entity
Organization
Contact information
Practice address
1045 ATLANTIC AVE, 719, LONG BEACH, CA 90813-3412
(562) 591-1324
(562) 437-1054
Mailing address
1045 ATLANTIC AVE, 719, LONG BEACH, CA 90813-3412
(562) 591-1324
(562) 437-1054
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP2733
RAIL ROAD MEDICARE
CA
05
—
GR0004090
—
CA
01
—
W6126
PTAN PROVIDER IDENTIFIER, MEDICARE
CA
Enumeration date
06/30/2005
Last updated
07/21/2022
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