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General NPI Number Information
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NPI Number | 1114229895
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT CLINIC
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Dates
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Enumeration Date | 12/01/2010
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 401 N JEFFERSON ST
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City | NEW CASTLE
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State | PA
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Zip | 16101-2238
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Country | US
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Telephone | 724-657-9262
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Fax | 724-657-9261
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Provider Business Mailing Address
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Address Line | PO BOX 8157
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City | NEW CASTLE
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State | PA
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Zip | 16107-8157
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Country | US
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Telephone | 724-657-9262
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Fax | 724-657-9261
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Authorized Official
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Title or Position | PROPRIETOR
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Name | DR. ASHRAF RAZZAK
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Credential | M.D.
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Telephone | 724-657-9262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD064551L
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License Number State | PA
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