Provider Demographics
NPI:1174940985
Name:CEREBRUM MD, PLLC
Entity type:Organization
Organization Name:CEREBRUM MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-748-1000
Mailing Address - Street 1:8230 BOONE BLVD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2621
Mailing Address - Country:US
Mailing Address - Phone:703-748-1000
Mailing Address - Fax:703-748-1010
Practice Address - Street 1:8230 BOONE BLVD
Practice Address - Street 2:SUITE 360
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2621
Practice Address - Country:US
Practice Address - Phone:703-748-1000
Practice Address - Fax:703-748-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101239497207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty