Provider Demographics
NPI:1902007545
Name:CUMBERLAND VALLEY PAIN MANAGEMENT, PC
Entity Type:Organization
Organization Name:CUMBERLAND VALLEY PAIN MANAGEMENT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:KOSENSKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-249-9222
Mailing Address - Street 1:5 TYLER CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-7671
Mailing Address - Country:US
Mailing Address - Phone:717-249-9222
Mailing Address - Fax:717-249-5345
Practice Address - Street 1:5 TYLER CT
Practice Address - Street 2:SUITE B
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-7671
Practice Address - Country:US
Practice Address - Phone:717-249-9222
Practice Address - Fax:717-249-5345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043353L208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012887110006Medicaid
PA0012887110006Medicaid
725759Medicare ID - Type Unspecified