MEDICARE: INTERVENTIONAL PAIN CENTER, PLLC

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	200100673	NC

General Provider Information

NPI Number	:	1255877171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERVENTIONAL PAIN CENTER, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 931038
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-1038
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 SUNNYBROOK RD
Second Line	:	SUITE 130
City	:	RALEIGH
State	:	NC
Zip	:	27610-2783
Country	:	US
Telephone Number	:	984-200-5318
Fax Number	:	984-200-5321

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	VIREN DINKERRAI DESAI
Credential	:	MD
Telephone Number	:	910-321-7246

Provider Enumeration Date	:	01/17/2017
Last Update Date	:	06/02/2025

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