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General NPI Number Information
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NPI Number | 1689731846
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Entity Type | Organization
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Legal Business Name | WESTERN CAROLINA NEUROLOGY PLLC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 709 NORTH JUSTICE ST SUITE D
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City | HENDERSONVILLE
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State | NC
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Zip | 28791-3454
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Country | US
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Telephone | 828-696-8881
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Fax | 828-696-8874
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Provider Business Mailing Address
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Address Line | 709 NORTH JUSTICE ST SUITE D
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City | HENDERSONVILLE
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State | NC
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Zip | 28791-3454
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Country | US
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Telephone | 828-696-8881
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Fax | 828-696-8874
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK A. MANDELBAUM
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Credential | MD
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Telephone | 828-696-8881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 200601663
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License Number State | NC
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