Provider Demographics
NPI:1619986528
Name:ALLEGHENY PAIN MANAGEMENT PC
Entity Type:Organization
Organization Name:ALLEGHENY PAIN MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DRASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-940-2000
Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:DEPT 866
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1402 9TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2415
Practice Address - Country:US
Practice Address - Phone:814-940-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053729L207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1556837OtherGATEWAY
PA203262OtherUPMC
PACJ9284OtherRAILROAD MEDICARE
PA120805400OtherOWCP
PADR973946OtherPERSONAL BS PROVIDER #
PA343086OtherADVANTRA FREEDOM
PA0018776120008Medicaid
PAAL1341803OtherHIGHMARK BC BS
PA1556837OtherGATEWAY
PA055981Medicare ID - Type Unspecified
PA011349QD2Medicare ID - Type UnspecifiedDR'S PERSONAL MEDICARE #