Provider Demographics
NPI:1902348659
Name:1ST MEDICAL PAIN MANAGEMENT SPECIALISTS
Entity type:Organization
Organization Name:1ST MEDICAL PAIN MANAGEMENT SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:INGADO
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:410-956-6800
Mailing Address - Street 1:20 MAYO RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-1439
Mailing Address - Country:US
Mailing Address - Phone:410-956-6800
Mailing Address - Fax:410-956-6803
Practice Address - Street 1:20 MAYO RD STE 201
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-1442
Practice Address - Country:US
Practice Address - Phone:410-956-6800
Practice Address - Fax:410-956-6803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1ST MEDICAL OF ANNAPOLIS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-11
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP3300X, 261QR0400X, 261QR0401X, 261QR0405X, 101YA0400X, 1041C0700X, 174400000X, 261QM0850X, 261Q00000X
MDD40904171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Multi-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD923020300Medicaid