MEDICARE: NEUROLOGY, NEURODIAGNOSTIC & PAIN CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DD4074	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942214242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROLOGY, NEURODIAGNOSTIC & PAIN CLINIC

Provider Business Mailing Address
First Line	:	PO BOX 734
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28111-0734
Country	:	US
Telephone Number	:	704-283-8811
Fax Number	:	704-283-2980

Provider Business Practice Location Address
First Line	:	1414 ELLEN ST
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28112-5173
Country	:	US
Telephone Number	:	704-283-8811
Fax Number	:	704-283-2980

Authorized Official
Title or Position	:	DOCTOR
Name	:	CHOCK TSERING
Credential	:	MD
Telephone Number	:	704-283-8811

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	04/29/2008

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