Provider Demographics
NPI:1013582014
Name:STOVER, BRENT FARLEY JR
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:FARLEY
Last Name:STOVER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:J.R.
Other - Middle Name:
Other - Last Name:STOVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:629 CIDERBERRY DR
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-6831
Mailing Address - Country:US
Mailing Address - Phone:304-542-6730
Mailing Address - Fax:
Practice Address - Street 1:INSTITUTE FOR PAIN MEDICINE
Practice Address - Street 2:5124 LIBERTY AVE
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224
Practice Address - Country:US
Practice Address - Phone:412-315-3810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)