Provider Demographics
NPI:1326049388
Name:PA INSTITUTE OF NEUROLOGICAL DISORDER PC
Entity Type:Organization
Organization Name:PA INSTITUTE OF NEUROLOGICAL DISORDER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:NASIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-286-9878
Mailing Address - Street 1:512 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-2338
Mailing Address - Country:US
Mailing Address - Phone:570-286-9878
Mailing Address - Fax:570-286-9848
Practice Address - Street 1:512 MARKET ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-2338
Practice Address - Country:US
Practice Address - Phone:570-286-9878
Practice Address - Fax:570-286-9848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039921Y2084N0400X, 2084N0600X, 2084P2900X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0000CM6837OtherRAILROAD MEDICARE
205802OtherBLACKLUNG
FLME93711OtherFL LICENSE
0015096800004OtherPA MEDICAL ASSISTANCE
PA0015096800004Medicaid
PA4397783OtherAETNA
7991260OtherGATEWAY
991260OtherKEYSTONE
PA1905677OtherPA BLUE SHIELD
02301600OtherCAPITAL BLUE CROSS
PAMD039921YOtherPA LICENSE
PAT05677OtherAMERIHEALTH
PAT05677OtherAMERIHEALTH
PA4397783OtherAETNA
PA0015096800004Medicaid
02301600OtherCAPITAL BLUE CROSS
991260OtherKEYSTONE