Healthcare Provider Details

I. General information

NPI: 1679582738
Provider Name (Legal Business Name): D&R PAIN MANAGEMENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 EDGEWOOD DR. EXT.
TRANSFER PA
16154
US

IV. Provider business mailing address

PO BOX 1088
HERMITAGE PA
16148-0088
US

V. Phone/Fax

Practice location:
  • Phone: 724-646-0400
  • Fax:
Mailing address:
  • Phone: 724-528-1088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: ELLEN LIST
Title or Position: MANAGER
Credential:
Phone: 724-528-1088