Provider Demographics
NPI:1558361790
Name:GRIVER, AVNER R (MD)
Entity Type:Individual
Prefix:
First Name:AVNER
Middle Name:R
Last Name:GRIVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:414 E DRINKER ST REAR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-2469
Mailing Address - Country:US
Mailing Address - Phone:570-558-2050
Mailing Address - Fax:570-558-2056
Practice Address - Street 1:414 E DRINKER ST REAR
Practice Address - Street 2:SUITE 203
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-2469
Practice Address - Country:US
Practice Address - Phone:570-558-2050
Practice Address - Fax:570-558-2056
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD059273L208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA826760OtherFIRST PRIORITY HEALTH
PA0016088840015Medicaid
PA872482Medicare PIN
PAF74401Medicare UPIN