Provider Demographics
NPI:1902853047
Name:DELAWARE VALLEY PAIN MANAGEMENT PC
Entity Type:Organization
Organization Name:DELAWARE VALLEY PAIN MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNIGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-947-7992
Mailing Address - Street 1:1800 BYBERRY RD
Mailing Address - Street 2:SUITE 1101
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-3518
Mailing Address - Country:US
Mailing Address - Phone:215-947-7992
Mailing Address - Fax:215-947-7969
Practice Address - Street 1:1800 BYBERRY RD
Practice Address - Street 2:SUITE 1101
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-3518
Practice Address - Country:US
Practice Address - Phone:215-947-7992
Practice Address - Fax:215-947-7969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2075628000OtherIBC
PA3049137OtherAETNA