Provider Demographics
NPI:1770065997
Name:THREE RIVERS PAIN MANAGEMENT ASSOCIATES PLLC
Entity type:Organization
Organization Name:THREE RIVERS PAIN MANAGEMENT ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUDHAKAR
Authorized Official - Middle Name:B
Authorized Official - Last Name:MANNAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-812-5580
Mailing Address - Street 1:736 W INGOMAR RD UNIT 116
Mailing Address - Street 2:
Mailing Address - City:INGOMAR
Mailing Address - State:PA
Mailing Address - Zip Code:15127-6604
Mailing Address - Country:US
Mailing Address - Phone:201-804-2800
Mailing Address - Fax:
Practice Address - Street 1:236 ELM DR STE 105
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-8265
Practice Address - Country:US
Practice Address - Phone:724-812-5580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty