Provider Demographics
NPI:1336185164
Name:NEUROLOGY & HEADACHE CLINIC PLLC
Entity Type:Organization
Organization Name:NEUROLOGY & HEADACHE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARSHANKUMAR
Authorized Official - Middle Name:ASHWINBHAI
Authorized Official - Last Name:DAVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-343-4400
Mailing Address - Street 1:3100 MACCORKLE AVE SE STE 411
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1230
Mailing Address - Country:US
Mailing Address - Phone:304-343-4400
Mailing Address - Fax:304-345-5005
Practice Address - Street 1:3100 MACCORKLE AVE SE
Practice Address - Street 2:SUITE 802
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-343-4400
Practice Address - Fax:304-345-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV211172084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1841796000Medicaid
4106681Medicare ID - Type Unspecified
H84081Medicare UPIN