MEDICARE: FRANKFORD MEDICAL AND PAIN MANAGEMENT LLC

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	207QA0401X	Addiction Medicine (Family Medicine) Physician	MD044909E	PA

General Provider Information

NPI Number	:	1992948038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRANKFORD MEDICAL AND PAIN MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	PO BOX 23169
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-0169
Country	:	US
Telephone Number	:	215-288-0159
Fax Number	:	215-288-0169

Provider Business Practice Location Address
First Line	:	4911 FRANKFORD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-2617
Country	:	US
Telephone Number	:	215-288-0159
Fax Number	:	215-288-0169

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. KEVIN ANTHONY CHAVARRIA
Credential	:	M. D.
Telephone Number	:	215-288-0159

Provider Enumeration Date	:	04/17/2009
Last Update Date	:	04/17/2009

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