Provider Demographics
NPI:1700507829
Name:PHILADELPHIA PAIN PRACTICE
Entity Type:Organization
Organization Name:PHILADELPHIA PAIN PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HUAGUANG
Authorized Official - Middle Name:
Authorized Official - Last Name:QU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:445-666-3202
Mailing Address - Street 1:825 SPRING HOUSE FARM LN
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2172
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 N BROAD ST FL 6
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1554
Practice Address - Country:US
Practice Address - Phone:215-546-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty