Provider Demographics
NPI:1467180455
Name:THREE RIVERS PAIN MANAGEMENT ASSOCIATES PLLC
Entity Type:Organization
Organization Name:THREE RIVERS PAIN MANAGEMENT ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUDHAKAR
Authorized Official - Middle Name:B
Authorized Official - Last Name:MANNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-812-5580
Mailing Address - Street 1:736 W INGOMAR RD UNIT 116
Mailing Address - Street 2:
Mailing Address - City:INGOMAR
Mailing Address - State:PA
Mailing Address - Zip Code:15127-6604
Mailing Address - Country:US
Mailing Address - Phone:201-804-2800
Mailing Address - Fax:201-804-8883
Practice Address - Street 1:20826 ROUTE 19
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6028
Practice Address - Country:US
Practice Address - Phone:866-216-7982
Practice Address - Fax:724-812-5682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-09
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty