Organization
REHAB DIAGNOSTICS AND PAIN MEDICINE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. YASSER GOUDA (OWNER)
(267) 428-6454
Entity
Organization
Contact information
Practice address
2121 N BROAD ST, LANSDALE, PA 19446-1054
(267) 428-6454
(267) 428-6457
Mailing address
2121 N BROAD ST, LANSDALE, PA 19446-1054
(267) 428-6454
(267) 428-6457
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
MD066786L
PA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
MD066786L
PA
208VP0000X
Pain Medicine Physician
MD066786L
PA
Other
Enumeration date
04/01/2015
Last updated
06/19/2015
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