Provider Demographics
NPI:1467619924
Name:COMMONWEALTH NEURO-SCIENCE INSTITUTE PLLC
Entity Type:Organization
Organization Name:COMMONWEALTH NEURO-SCIENCE INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:985-855-8405
Mailing Address - Street 1:850 HAIL KNOB RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-3418
Mailing Address - Country:US
Mailing Address - Phone:606-425-4141
Mailing Address - Fax:606-425-4142
Practice Address - Street 1:850 HAIL KNOB RD
Practice Address - Street 2:SUITE A
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3418
Practice Address - Country:US
Practice Address - Phone:606-425-4141
Practice Address - Fax:606-425-4142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY030912084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00674OtherMEDICARE PTAN