Provider Demographics
NPI:1346277308
Name:PAIN MANAGEMENT SPECIALISTS, PC
Entity type:Organization
Organization Name:PAIN MANAGEMENT SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-453-9182
Mailing Address - Street 1:15200 SHADY GROVE RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3218
Mailing Address - Country:US
Mailing Address - Phone:240-453-9182
Mailing Address - Fax:
Practice Address - Street 1:15200 SHADY GROVE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3218
Practice Address - Country:US
Practice Address - Phone:240-453-9182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC783262Medicare PIN
MD154183Medicare PIN