Provider Demographics
NPI:1629201314
Name:COTTMAN & CASTOR PAIN MANAGEMENT
Entity Type:Organization
Organization Name:COTTMAN & CASTOR PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CHAVARRIA
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:215-745-7970
Mailing Address - Street 1:1934 COTTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-3817
Mailing Address - Country:US
Mailing Address - Phone:215-745-7970
Mailing Address - Fax:215-745-7972
Practice Address - Street 1:1934 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3817
Practice Address - Country:US
Practice Address - Phone:215-745-7970
Practice Address - Fax:215-745-7972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044909E207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty