Basic Information
| Provider Information | |||||||||
| NPI: | 1003212788 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RA PAIN SERVICES, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15000 MIDLANTIC DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080541573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562555479 | ||||||||
| FaxNumber: | 8563938481 | ||||||||
| Practice Location | |||||||||
| Address1: | 329 GREENTREE RD | ||||||||
| Address2: | |||||||||
| City: | SEWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080809229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562287246 | ||||||||
| FaxNumber: | 8562287252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2014 | ||||||||
| LastUpdateDate: | 08/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | HALEEM | ||||||||
| AuthorizedOfficialFirstName: | BURHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8557272465 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 25MA06131600 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.