Healthcare Provider Details

I. General information

NPI: 1487835500
Provider Name (Legal Business Name): MOUNT AIRY PAIN MANAGEMENT CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6613 CHEW AVE
PHILADELPHIA PA
19119-2002
US

IV. Provider business mailing address

6613 CHEW AVE
PHILADELPHIA PA
19119-2002
US

V. Phone/Fax

Practice location:
  • Phone: 215-848-1166
  • Fax: 215-842-0224
Mailing address:
  • Phone: 215-848-1166
  • Fax: 215-842-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberMD063864L
License Number StatePA

VIII. Authorized Official

Name: DR. OBIOMA C. IRO-NWOKEUKWU III
Title or Position: PAIN SPECIALIST, ANESTHESIOLOGIST
Credential: MD063864L
Phone: 215-848-1166