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General NPI Number Information
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NPI Number | 1821353871
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT OF WILLIAMSPORT, LLC
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 553 E 3RD ST
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-5316
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Country | US
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Telephone | 570-323-3106
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Fax | 570-323-3606
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Provider Business Mailing Address
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Address Line | 553 E 3RD ST
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-5316
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Country | US
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Telephone | 570-323-3106
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Fax | 570-323-3606
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Authorized Official
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Title or Position | M.D.
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Name | DR. AYAZ M KHAN
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Credential |
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Telephone | 570-323-3106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | MD435280
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License Number State | PA
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