Basic Information
| Provider Information | |||||||||
| NPI: | 1568702124 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BETHESDA PAIN MANAGEMENT LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 79794 | ||||||||
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| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212790794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4432742900 | ||||||||
| FaxNumber: | 4432742391 | ||||||||
| Practice Location | |||||||||
| Address1: | 6000 EXECUTIVE BLVD | ||||||||
| Address2: | 510 | ||||||||
| City: | N BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208523803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017707900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2013 | ||||||||
| LastUpdateDate: | 02/19/2013 | ||||||||
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| AuthorizedOfficialLastName: | JACH | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 3017707900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | D0033495 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.