Provider Demographics
NPI:1306818869
Name:EASTERN SHORE NEUROLOGY AND PAIN CLINIC
Entity Type:Organization
Organization Name:EASTERN SHORE NEUROLOGY AND PAIN CLINIC
Other - Org Name:EASTERN SHORE NEUROLOGY AND PAIN CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:RASSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TARABEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-971-3030
Mailing Address - Street 1:149 W PEACHTREE AVE
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2239
Mailing Address - Country:US
Mailing Address - Phone:251-971-3030
Mailing Address - Fax:251-971-3035
Practice Address - Street 1:149 W PEACHTREE AVE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2239
Practice Address - Country:US
Practice Address - Phone:251-971-3030
Practice Address - Fax:251-971-3035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL18124174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALJ619OtherMEDICARE GROUP
AL0510348OtherUNITED HEALTHCARE
AL51034929OtherBLUE CROSS BLUE SHIELD
AL5940140OtherAETNA
AL0510010OtherUNITED HAELTHCARE
AL51506401OtherBLUE CROSS BLUE SHIELD
ALP00033163OtherMEDICARE RAILROAD
AL0510010OtherUNITED HAELTHCARE
ALJ619OtherMEDICARE GROUP