Provider Demographics
NPI:1386015972
Name:PHYSICAL MEDICINE ASSOCIATES, LTD
Entity type:Organization
Organization Name:PHYSICAL MEDICINE ASSOCIATES, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIDELIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-914-8000
Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EXECUTIVE PLAZA 1, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1002
Mailing Address - Country:US
Mailing Address - Phone:631-445-0593
Mailing Address - Fax:
Practice Address - Street 1:1460 PANTOPS MOUNTAIN PL
Practice Address - Street 2:SUITE 2B
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-4600
Practice Address - Country:US
Practice Address - Phone:434-234-4910
Practice Address - Fax:434-327-1799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty