Provider Demographics
NPI:1194782953
Name:PHYSICIANS PAIN CARE, LLC
Entity type:Organization
Organization Name:PHYSICIANS PAIN CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTALENE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SALDANHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-273-2570
Mailing Address - Street 1:PO BOX 62037
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2037
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:998 HOSPITALITY WAY
Practice Address - Street 2:SUITE A
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-1779
Practice Address - Country:US
Practice Address - Phone:410-273-2570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD254POtherCAREFIRST BCBS
MD410399800Medicaid
MD254PMedicare PIN
MD410399800Medicaid