Healthcare Provider Details

I. General information

NPI: 1992948038
Provider Name (Legal Business Name): FRANKFORD MEDICAL AND PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4911 FRANKFORD AVE
PHILADELPHIA PA
19124-2617
US

IV. Provider business mailing address

PO BOX 23169
PHILADELPHIA PA
19124-0169
US

V. Phone/Fax

Practice location:
  • Phone: 215-288-0159
  • Fax: 215-288-0169
Mailing address:
  • Phone: 215-288-0159
  • Fax: 215-288-0169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD044909E
License Number StatePA

VIII. Authorized Official

Name: DR. KEVIN ANTHONY CHAVARRIA
Title or Position: MANAGER
Credential: M. D.
Phone: 215-288-0159