Provider Demographics
NPI:1285779454
Name:CARLISLE NEUROCARE, INC
Entity type:Organization
Organization Name:CARLISLE NEUROCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:K
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-249-8283
Mailing Address - Street 1:220 WILSON ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-3697
Mailing Address - Country:US
Mailing Address - Phone:717-249-8283
Mailing Address - Fax:717-249-8254
Practice Address - Street 1:220 WILSON ST
Practice Address - Street 2:SUITE 210
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3697
Practice Address - Country:US
Practice Address - Phone:717-249-8283
Practice Address - Fax:717-249-8254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD421261174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG61279Medicare UPIN
PA071977Medicare ID - Type Unspecified