MEDICARE: PAIN AND ORTHOPEDIC NEUROLOGY, PA

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	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician	28819	NC

General Provider Information

NPI Number	:	1083631824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN AND ORTHOPEDIC NEUROLOGY, PA

Provider Business Mailing Address
First Line	:	3711 LATROBE DR STE 530
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1664
Country	:	US
Telephone Number	:	704-365-0966
Fax Number	:	704-362-3691

Provider Business Practice Location Address
First Line	:	3711 LATROBE DR STE 530
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1664
Country	:	US
Telephone Number	:	704-365-0966
Fax Number	:	704-362-3691

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANTHONY HALLOCK WHEELER
Credential	:	M.D.
Telephone Number	:	704-365-0966

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/14/2010

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