Provider Demographics
NPI:1396702916
Name:REHABILITATION MEDICINE SERVICES PC
Entity type:Organization
Organization Name:REHABILITATION MEDICINE SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AFSHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMADON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-362-1112
Mailing Address - Street 1:PO BOX 7217
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28406
Mailing Address - Country:US
Mailing Address - Phone:910-362-1112
Mailing Address - Fax:910-362-1115
Practice Address - Street 1:1914 MEETING CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6631
Practice Address - Country:US
Practice Address - Phone:910-362-1112
Practice Address - Fax:910-362-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27487208100000X
NC9800403208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC274875Medicaid
NC790287FMedicaid
SC8207Medicare PIN
NC2247694AMedicare PIN
NC790287FMedicaid