Provider Demographics
NPI:1093733933
Name:ADVANCED PAIN MEDICINE PC
Entity Type:Organization
Organization Name:ADVANCED PAIN MEDICINE PC
Other - Org Name:ADVANCED PAIN MEDICINE PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:LODICO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-933-0300
Mailing Address - Street 1:7000 STONEWOOD DR
Mailing Address - Street 2:STE 151
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090
Mailing Address - Country:US
Mailing Address - Phone:724-933-0300
Mailing Address - Fax:724-933-0456
Practice Address - Street 1:7000 STONEWOOD DR
Practice Address - Street 2:STE 151
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8386
Practice Address - Country:US
Practice Address - Phone:724-933-0300
Practice Address - Fax:724-933-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047135L208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA361577OtherHIGHMARK
PA224979OtherHEALTH AMERICA
PA224979OtherHEALTH AMERICA
PA361577OtherHIGHMARK
PA6367390001Medicare NSC