Provider Demographics
NPI:1972744266
Name:WESTERN CAROLINA NEUROLOGY
Entity Type:Organization
Organization Name:WESTERN CAROLINA NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALON
Authorized Official - Last Name:MANDELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-636-8881
Mailing Address - Street 1:55 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-2651
Mailing Address - Country:US
Mailing Address - Phone:828-696-8881
Mailing Address - Fax:828-696-8874
Practice Address - Street 1:709 N JUSTICE ST
Practice Address - Street 2:SUITE D
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3454
Practice Address - Country:US
Practice Address - Phone:828-696-8881
Practice Address - Fax:828-696-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006016632084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B68541Medicare PIN