Provider Demographics
NPI:1962788323
Name:MARYLAND REHAB AND PAIN SPECIALISTS,LLC
Entity type:Organization
Organization Name:MARYLAND REHAB AND PAIN SPECIALISTS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:X
Authorized Official - Last Name:GAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-884-9293
Mailing Address - Street 1:5070 DORSEY HALL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7711
Mailing Address - Country:US
Mailing Address - Phone:410-884-9293
Mailing Address - Fax:410-884-6933
Practice Address - Street 1:5070 DORSEY HALL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7711
Practice Address - Country:US
Practice Address - Phone:410-884-9293
Practice Address - Fax:410-884-6933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057718305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH49410Medicare UPIN