Provider Demographics
NPI:1992948038
Name:FRANKFORD MEDICAL AND PAIN MANAGEMENT LLC
Entity type:Organization
Organization Name:FRANKFORD MEDICAL AND PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CHAVARRIA
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:215-288-0159
Mailing Address - Street 1:PO BOX 23169
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-0169
Mailing Address - Country:US
Mailing Address - Phone:215-288-0159
Mailing Address - Fax:215-288-0169
Practice Address - Street 1:4911 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-2617
Practice Address - Country:US
Practice Address - Phone:215-288-0159
Practice Address - Fax:215-288-0169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044909E207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty