Provider Demographics
NPI:1104871060
Name:NEUROSCAN
Entity type:Organization
Organization Name:NEUROSCAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SIGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-296-7156
Mailing Address - Street 1:175 LENNON LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2485
Mailing Address - Country:US
Mailing Address - Phone:925-296-7156
Mailing Address - Fax:925-296-7174
Practice Address - Street 1:115 LA CASA VIA
Practice Address - Street 2:SUITE 202
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3042
Practice Address - Country:US
Practice Address - Phone:925-296-7156
Practice Address - Fax:925-296-7174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACI4954Medicare PIN
CAYYY49530YMedicare PIN