Healthcare Provider Details

I. General information

NPI: 1841277464
Provider Name (Legal Business Name): CENTER FOR PAIN MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 07/19/2007
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 8500-4066
PHILADELPHIA PA
19718-4066
US

V. Phone/Fax

Practice location:
  • Phone: 610-789-8070
  • Fax:
Mailing address:
  • Phone: 302-709-4497
  • Fax: 302-733-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD027057E
License Number StatePA

VIII. Authorized Official

Name: WILLIAM GOLDSTEIN
Title or Position: CO-OWNER
Credential: M.D.
Phone: 610-789-8070