Provider Demographics
NPI:1245400654
Name:PIEDMONT PAIN MEDICINE P.C.
Entity Type:Organization
Organization Name:PIEDMONT PAIN MEDICINE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:WINIKUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-685-7855
Mailing Address - Street 1:10384 MARTINSVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-6885
Mailing Address - Country:US
Mailing Address - Phone:434-685-7855
Mailing Address - Fax:434-685-7929
Practice Address - Street 1:10384 MARTINSVILLE HWY
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-6885
Practice Address - Country:US
Practice Address - Phone:434-685-7855
Practice Address - Fax:434-685-7929
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIEDMONT PAIN MEDICINE P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-03
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101059090208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA245882OtherBCBS
VA007000057Medicaid
VA384993OtherBC/BS (ANTHEM) WINIKUR
VAE90631Medicare UPIN
VA720000003Medicare PIN