Provider Demographics
NPI:1093323875
Name:CAROLINA NEUROLOGY & NEUROIMAGING LLC
Entity Type:Organization
Organization Name:CAROLINA NEUROLOGY & NEUROIMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-716-2600
Mailing Address - Street 1:111 SHIRE DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-3675
Mailing Address - Country:US
Mailing Address - Phone:864-716-2600
Mailing Address - Fax:864-716-2666
Practice Address - Street 1:111 SHIRE DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3675
Practice Address - Country:US
Practice Address - Phone:864-716-2600
Practice Address - Fax:864-716-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC34121OtherSTATE LICENSE