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General NPI Number Information
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NPI Number | 1699700195
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL SPINE PAIN CONSULTANTS, PA
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 04/05/2017
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Provider Practice Location Address
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Address Line | 774 CHRISTIANA RD STE 111
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City | NEWARK
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State | DE
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Zip | 19713-4236
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Country | US
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Telephone | 302-478-7001
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Fax | 302-478-5101
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Provider Business Mailing Address
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Address Line | PO BOX 947
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City | CHAMBERSBURG
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State | PA
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Zip | 17201-0947
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Country | US
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Telephone | 717-263-5562
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Fax | 717-263-1566
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETER M WITHERELL
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Credential | MD
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Telephone | 302-478-7001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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