Provider Demographics
NPI:1205892916
Name:PINEHURST NEUROLOGY, PA
Entity type:Organization
Organization Name:PINEHURST NEUROLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:910-295-6868
Mailing Address - Street 1:PO BOX 1749
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28370-1749
Mailing Address - Country:US
Mailing Address - Phone:910-295-6868
Mailing Address - Fax:910-295-1514
Practice Address - Street 1:1 PAGE RD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8745
Practice Address - Country:US
Practice Address - Phone:910-295-6868
Practice Address - Fax:910-295-1514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQPAA999OtherSC MEDICAID
NC8901885Medicaid
NCC13689OtherRAILROAD MEDICARE
NC01885OtherBCBS NC
NC8901885Medicaid