Provider Demographics
NPI:1942214242
Name:NEUROLOGY, NEURODIAGNOSTIC & PAIN CLINIC
Entity Type:Organization
Organization Name:NEUROLOGY, NEURODIAGNOSTIC & PAIN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHOCK
Authorized Official - Middle Name:
Authorized Official - Last Name:TSERING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-283-8811
Mailing Address - Street 1:PO BOX 734
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28111-0734
Mailing Address - Country:US
Mailing Address - Phone:704-283-8811
Mailing Address - Fax:704-283-2980
Practice Address - Street 1:1414 ELLEN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5173
Practice Address - Country:US
Practice Address - Phone:704-283-8811
Practice Address - Fax:704-283-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCDD4074OtherRAILROAD MEDICARE
NC89129YAMedicaid
NC2329460Medicare PIN
NCDD4074OtherRAILROAD MEDICARE