Provider Demographics
NPI:1215986880
Name:PENNSYLVANIA PAIN MANAGEMENT, INC.
Entity type:Organization
Organization Name:PENNSYLVANIA PAIN MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHOQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-439-1662
Mailing Address - Street 1:1251 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6205
Mailing Address - Country:US
Mailing Address - Phone:610-439-1662
Mailing Address - Fax:610-439-8397
Practice Address - Street 1:1251 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6205
Practice Address - Country:US
Practice Address - Phone:610-439-1662
Practice Address - Fax:610-439-8397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02803100OtherCAPITAL BLUE CROSS
PA0000768841OtherHIGHMARK BLUE SHIELD
PA1520393OtherGATEWAY HEALTHPLAN
PAP3033420OtherOXFORD HEALTH PLAN
PA0016272440006Medicaid
PA823259OtherAETNA
PA0016272440006Medicaid
PA02803100OtherCAPITAL BLUE CROSS