Healthcare Provider Details

I. General information

NPI: 1972752434
Provider Name (Legal Business Name): TOTAL BODY PAIN MANAGEMENT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 BUSTLETON AVE SUITE 205
PHILADELPHIA PA
19152-1918
US

IV. Provider business mailing address

8400 BUSTLETON AVE SUITE 205
PHILADELPHIA PA
19152-1918
US

V. Phone/Fax

Practice location:
  • Phone: 215-342-3600
  • Fax: 215-342-3669
Mailing address:
  • Phone: 215-342-3600
  • Fax: 215-342-3669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS009083L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberOS009083L
License Number StatePA

VIII. Authorized Official

Name: DR. STUART A KAUFFMAN
Title or Position: OWNER
Credential: D.O.
Phone: 215-342-3600