MEDICARE: TOTAL BODY PAIN MANAGEMENT PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	OS009083L	PA
2	208VP0014X	Interventional Pain Medicine Physician	OS009083L	PA

General Provider Information

NPI Number	:	1972752434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL BODY PAIN MANAGEMENT PC

Provider Business Mailing Address
First Line	:	8400 BUSTLETON AVE
Second Line	:	SUITE 205
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-1918
Country	:	US
Telephone Number	:	215-342-3600
Fax Number	:	215-342-3669

Provider Business Practice Location Address
First Line	:	8400 BUSTLETON AVE
Second Line	:	SUITE 205
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-1918
Country	:	US
Telephone Number	:	215-342-3600
Fax Number	:	215-342-3669

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STUART A KAUFFMAN
Credential	:	D.O.
Telephone Number	:	215-342-3600

Provider Enumeration Date	:	09/09/2008
Last Update Date	:	07/12/2012

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