Provider Demographics
NPI:1750422929
Name:CAPITAL NEUROSCIENCE PA
Entity type:Organization
Organization Name:CAPITAL NEUROSCIENCE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-726-7705
Mailing Address - Street 1:3402 MANDY LN
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-3161
Mailing Address - Country:US
Mailing Address - Phone:252-726-7705
Mailing Address - Fax:252-726-7703
Practice Address - Street 1:3402 MANDY LN
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3161
Practice Address - Country:US
Practice Address - Phone:252-726-7705
Practice Address - Fax:252-726-7278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC345202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909117Medicaid
NC5909117Medicaid
NC2219709Medicare PIN