Provider Demographics
NPI:1255623880
Name:PAIN INSTITUTE OF CENTRAL PA PC
Entity type:Organization
Organization Name:PAIN INSTITUTE OF CENTRAL PA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSUFUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-218-8800
Mailing Address - Street 1:69 ST PAUL DR STE B
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-1020
Mailing Address - Country:US
Mailing Address - Phone:717-218-8800
Mailing Address - Fax:717-552-2196
Practice Address - Street 1:69 ST PAUL DR STE B
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1020
Practice Address - Country:US
Practice Address - Phone:717-218-8800
Practice Address - Fax:717-552-2196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422419207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD422419OtherPA LICENSE
1083607840OtherALI TYPE 1 NPI
PA100816820Medicaid
PAMD422419OtherPA LICENSE
H93920Medicare UPIN