Provider Demographics
NPI:1811271984
Name:LIVING WELL COMPREHENSIVE PAIN CENTER PC
Entity type:Organization
Organization Name:LIVING WELL COMPREHENSIVE PAIN CENTER PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PRIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAMY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-362-9143
Mailing Address - Street 1:PO BOX 7725
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-7725
Mailing Address - Country:US
Mailing Address - Phone:484-461-8154
Mailing Address - Fax:
Practice Address - Street 1:3001 GARRETT RD
Practice Address - Street 2:B
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-2201
Practice Address - Country:US
Practice Address - Phone:484-461-8154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIVING WELL COMPREHENSIVE PAIN CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-06
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4225522081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty