Provider Demographics
NPI:1316754054
Name:GREATER MARYLAND PAIN MANAGEMENT, LLC
Entity type:Organization
Organization Name:GREATER MARYLAND PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. BILLING ACAOORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-672-2255
Mailing Address - Street 1:1130 ANNAPOLIS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1622
Mailing Address - Country:US
Mailing Address - Phone:410-982-9506
Mailing Address - Fax:410-816-9472
Practice Address - Street 1:41680 MISS BESSIE DR STE 303
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2965
Practice Address - Country:US
Practice Address - Phone:410-672-2255
Practice Address - Fax:410-816-9472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty