Healthcare Provider Details

I. General information

NPI: 1497740963
Provider Name (Legal Business Name): CENTER FOR PAIN MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 OLD WEST CHESTER PIKE STE 330
HAVERTOWN PA
19083-2712
US

IV. Provider business mailing address

PO BOX 1250
HAVERTOWN PA
19083-5850
US

V. Phone/Fax

Practice location:
  • Phone: 717-263-5562
  • Fax: 717-263-1566
Mailing address:
  • Phone: 717-263-5562
  • Fax: 717-263-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StatePA

VIII. Authorized Official

Name: WILLIAM ISAACSON
Title or Position: PRESIDENT
Credential: MD
Phone: 610-789-8070