Provider Demographics
NPI:1841277464
Name:CENTER FOR PAIN MEDICINE PC
Entity type:Organization
Organization Name:CENTER FOR PAIN MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-789-8070
Mailing Address - Street 1:PO BOX 8500-4066
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19718-4066
Mailing Address - Country:US
Mailing Address - Phone:302-709-4497
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:2010 OLD WEST CHESTER PIKE
Practice Address - Street 2:STE. 330
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2712
Practice Address - Country:US
Practice Address - Phone:610-789-8070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027057E207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000014095Medicaid
PA0019015850004Medicaid
DEG00915Medicare PIN
DE1000014095Medicaid