Provider Demographics
NPI:1841432358
Name:PAIN MANAGEMENT SPECIALIST AND ASSOCIATES
Entity Type:Organization
Organization Name:PAIN MANAGEMENT SPECIALIST AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:VALENTINO
Authorized Official - Last Name:MCCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:412-654-5464
Mailing Address - Street 1:322 MALL BLVD.
Mailing Address - Street 2:172
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2229
Mailing Address - Country:US
Mailing Address - Phone:412-654-5464
Mailing Address - Fax:
Practice Address - Street 1:322 MALL BLVD.
Practice Address - Street 2:172
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15146-2229
Practice Address - Country:US
Practice Address - Phone:412-654-5464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASCOO2810L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA167954Other098534