Provider Demographics
NPI:1891152096
Name:CHOICE PAIN & REHABILITATION CENTER
Entity type:Organization
Organization Name:CHOICE PAIN & REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TRISTAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHOCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-489-1125
Mailing Address - Street 1:9900 GREENBELT ROAD
Mailing Address - Street 2:SUITE E117
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-0605
Mailing Address - Country:US
Mailing Address - Phone:240-786-1001
Mailing Address - Fax:240-786-1002
Practice Address - Street 1:9841 GREENBELT RD
Practice Address - Street 2:SUITE 208
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706
Practice Address - Country:US
Practice Address - Phone:240-786-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD150108291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory