Provider Demographics
NPI:1740570886
Name:GERMANTOWN PAIN MANAGEMENT & PHYSICAL THERAPY
Entity Type:Organization
Organization Name:GERMANTOWN PAIN MANAGEMENT & PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CHAVARRIA
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:267-265-4423
Mailing Address - Street 1:PO BOX 18867
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-0867
Mailing Address - Country:US
Mailing Address - Phone:215-848-3216
Mailing Address - Fax:
Practice Address - Street 1:6334 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-1935
Practice Address - Country:US
Practice Address - Phone:215-848-3216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044909E207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty