Provider Demographics
NPI:1285054775
Name:DELAWARE PAIN RELIEF CENTER PA
Entity type:Organization
Organization Name:DELAWARE PAIN RELIEF CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FICCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-838-2081
Mailing Address - Street 1:1220 PEOPLES PLZ
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5701
Mailing Address - Country:US
Mailing Address - Phone:302-838-2081
Mailing Address - Fax:
Practice Address - Street 1:1220 PEOPLES PLZ
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5701
Practice Address - Country:US
Practice Address - Phone:302-838-2081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
354232Medicare PIN