Healthcare Provider Details

I. General information

NPI: 1649766742
Provider Name (Legal Business Name): SMR PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 RIDGEWOOD RD STE 200
WYOMISSING PA
19610-1196
US

IV. Provider business mailing address

1705 SOMERSET ST
DRESHER PA
19025-1312
US

V. Phone/Fax

Practice location:
  • Phone: 610-375-6226
  • Fax: 484-509-2933
Mailing address:
  • Phone: 215-338-1811
  • Fax: 215-338-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALD LINCOW
Title or Position: OWNER
Credential: DO
Phone: 215-338-1811