Provider Demographics
NPI:1609907138
Name:NEUROLOGY & PAIN MANAGEMENT, PLLC
Entity Type:Organization
Organization Name:NEUROLOGY & PAIN MANAGEMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NAILESH
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-893-9700
Mailing Address - Street 1:350 PINE STATE ST
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-9428
Mailing Address - Country:US
Mailing Address - Phone:910-893-9700
Mailing Address - Fax:910-893-9747
Practice Address - Street 1:350 PINE STATE ST
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-9428
Practice Address - Country:US
Practice Address - Phone:910-893-9700
Practice Address - Fax:910-893-9747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900027174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891209MMedicaid
NCG90065Medicare UPIN
NC2342294Medicare ID - Type UnspecifiedMEDICARE NUMBER