Healthcare Provider Details

I. General information

NPI: 1922111764
Provider Name (Legal Business Name): ERIE SPINE AND PAIN MANAGEMENT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 SIGSBEE STREET
ERIE PA
16508
US

IV. Provider business mailing address

6133 VOLKMAN ROAD
ERIE PA
16506
US

V. Phone/Fax

Practice location:
  • Phone: 814-454-4599
  • Fax: 814-454-4503
Mailing address:
  • Phone: 814-454-4599
  • Fax: 814-454-4503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. PREETHI RAI
Title or Position: ADMINISTATOR
Credential: MS
Phone: 814-454-4599