Provider Demographics
NPI:1528285749
Name:COMPREHENSIVE NEUROLOGY CLINIC PA
Entity type:Organization
Organization Name:COMPREHENSIVE NEUROLOGY CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-208-0708
Mailing Address - Street 1:10967 LAKE UNDERHILL RD
Mailing Address - Street 2:SUITE 148
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-4457
Mailing Address - Country:US
Mailing Address - Phone:407-208-0708
Mailing Address - Fax:407-208-0709
Practice Address - Street 1:10967 LAKE UNDERHILL RD
Practice Address - Street 2:SUITE 148
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4457
Practice Address - Country:US
Practice Address - Phone:407-208-0708
Practice Address - Fax:407-208-0709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009029900Medicaid