Provider Demographics
NPI:1124051396
Name:NEUROLOGY AND PAIN CLINIC LLC
Entity type:Organization
Organization Name:NEUROLOGY AND PAIN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:I
Authorized Official - Last Name:ALHATOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-531-8500
Mailing Address - Street 1:2850 PELHAM CT
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-1400
Mailing Address - Country:US
Mailing Address - Phone:803-531-8500
Mailing Address - Fax:803-533-5585
Practice Address - Street 1:2850 PELHAM CT
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-1400
Practice Address - Country:US
Practice Address - Phone:803-531-8500
Practice Address - Fax:803-533-5585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8166Medicare PIN