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General NPI Number Information
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NPI Number | 1306818869
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Entity Type | Organization
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Legal Business Name | EASTERN SHORE NEUROLOGY AND PAIN CLINIC
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 149 W PEACHTREE AVE
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City | FOLEY
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State | AL
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Zip | 36535-2239
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Country | US
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Telephone | 251-971-3030
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Fax | 251-971-3035
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Provider Business Mailing Address
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Address Line | 149 W PEACHTREE AVE
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City | FOLEY
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State | AL
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Zip | 36535-2239
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Country | US
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Telephone | 251-971-3030
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Fax | 251-971-3035
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Authorized Official
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Title or Position | C.E.O.
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Name | DR. RASSAN M TARABEIN
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Credential | M.D.
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Telephone | 251-971-3030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | AL18124
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License Number State | AL
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