Basic Information
| Provider Information | |||||||||
| NPI: | 1992095392 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTER FOR PAIN MANAGEMENT, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7120 MINSTREL WAY | ||||||||
| Address2: | STE 106 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210455248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102909191 | ||||||||
| FaxNumber: | 4102907330 | ||||||||
| Practice Location | |||||||||
| Address1: | 7120 MINSTREL WAY | ||||||||
| Address2: | STE 106 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210455248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102909191 | ||||||||
| FaxNumber: | 4102907330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2011 | ||||||||
| LastUpdateDate: | 10/14/2014 | ||||||||
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| AuthorizedOfficialLastName: | LOEV | ||||||||
| AuthorizedOfficialFirstName: | MARC | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3018817246 | ||||||||
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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 | 208VP0014X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.