Provider Demographics
NPI:1235365503
Name:HEADACHE INSTITUTE OF TIDEWATER LLC
Entity Type:Organization
Organization Name:HEADACHE INSTITUTE OF TIDEWATER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PUGACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-368-1891
Mailing Address - Street 1:780 LYNNHAVEN PKWY
Mailing Address - Street 2:SUITE 285
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7332
Mailing Address - Country:US
Mailing Address - Phone:757-368-1891
Mailing Address - Fax:757-368-4041
Practice Address - Street 1:780 LYNNHAVEN PKWY
Practice Address - Street 2:SUITE 285
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7332
Practice Address - Country:US
Practice Address - Phone:757-368-1891
Practice Address - Fax:757-368-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty