Healthcare Provider Details

I. General information

NPI: 1417904459
Provider Name (Legal Business Name): GWM PAIN MANAGEMENT ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 BYBERRY RD SUITE 1101
HUNTINGDON VALLEY PA
19006-3518
US

IV. Provider business mailing address

1800 BYBERRY RD SUITE 1101
HUNTINGDON VALLEY PA
19006-3518
US

V. Phone/Fax

Practice location:
  • Phone: 215-947-7992
  • Fax: 215-947-7969
Mailing address:
  • Phone: 215-947-7992
  • Fax: 215-947-7969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARIE HENNIGAR
Title or Position: OFFICE MANAGER
Credential:
Phone: 215-947-7992