Provider Demographics
NPI:1457883936
Name:MAYFAIR PAIN THERAPY CENTER PC
Entity Type:Organization
Organization Name:MAYFAIR PAIN THERAPY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:DWORKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-996-2018
Mailing Address - Street 1:6921 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-1623
Mailing Address - Country:US
Mailing Address - Phone:215-708-8887
Mailing Address - Fax:
Practice Address - Street 1:6921 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-1623
Practice Address - Country:US
Practice Address - Phone:215-708-8887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004891L208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty