Provider Demographics
NPI:1457499873
Name:PAIN CENTER OF DELAWARE
Entity Type:Organization
Organization Name:PAIN CENTER OF DELAWARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-644-2160
Mailing Address - Street 1:17274 COASTAL HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-6210
Mailing Address - Country:US
Mailing Address - Phone:302-644-2160
Mailing Address - Fax:302-644-8888
Practice Address - Street 1:17274 COASTAL HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-6210
Practice Address - Country:US
Practice Address - Phone:302-644-2160
Practice Address - Fax:302-644-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEH32192Medicare UPIN
DEG01841Medicare PIN