Healthcare Provider Details

I. General information

NPI: 1912116039
Provider Name (Legal Business Name): OLNEY PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 05/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 N FRONT ST
PHILADELPHIA PA
19120-1541
US

IV. Provider business mailing address

PO BOX 1006
BENSALEM PA
19020-5006
US

V. Phone/Fax

Practice location:
  • Phone: 215-224-2500
  • Fax: 215-224-4694
Mailing address:
  • Phone: 215-224-2500
  • Fax: 215-224-4694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: KELLY J BOYLE
Title or Position: MEDICAL ASSISTANT
Credential: MA
Phone: 215-750-9600