Provider Demographics
NPI:1003094442
Name:HEAG PAIN MANAGEMENT CENTER PA
Entity Type:Organization
Organization Name:HEAG PAIN MANAGEMENT CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KWADWO
Authorized Official - Middle Name:
Authorized Official - Last Name:GYARTENG DAKWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-220-0107
Mailing Address - Street 1:2609 N DYKE ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704
Mailing Address - Country:US
Mailing Address - Phone:919-220-0107
Mailing Address - Fax:
Practice Address - Street 1:2609 N DUKE ST STE 303B
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704
Practice Address - Country:US
Practice Address - Phone:919-220-0107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HEAG PAIN MANAGEMENT CENTER PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-07
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500050207L00000X, 208VP0000X, 208VP0014X
261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5700429Medicaid
1285678845OtherNPI
H64710Medicare UPIN