Organization · NPI-2

1st Medical Pain Management Specialists

Clinic/Center, Multi-Specialty · Oxon Hill, MD

NPI number1205501608

StatusActive

Last updated in NPPESJan 23, 2022

Details

NPI: 1205501608
Entity type: Organization (NPI-2)
Legal business name: 1st Medical Pain Management Specialists
Organization subpart: Yes
Enumeration date: Aug 9, 2021
Certification date: Jan 23, 2022
Last updated: Jan 23, 2022

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
261QM1300X	Clinic/Center, Multi-Specialty	–	–	Yes
101YA0400X	Counselor, Addiction (Substance Use Disorder)	–	–
101YM0800X	Counselor, Mental Health	–	–
1041C0700X	Social Worker, Clinical	–	–
133VN1201X	Dietitian, Registered, Nutrition, Obesity and Weight Management	–	–
261QM0850X	Clinic/Center, Adult Mental Health	–	–
261QP3300X	Clinic/Center, Pain	–	–
261QR0401X	Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)	–	–
261QR0405X	Clinic/Center, Rehabilitation, Substance Use Disorder	–	–

Other names

1st Medical Painrehab Center (Doing Business As)

Practice location

5620 Saint Barnabas Rd Ste 340
Oxon Hill, MD 20745-3628

Phone 301-747-4224 · Fax 410-956-6803

Mailing address

20 Mayo Rd Ste 201
Edgewater, MD 21037-1442

Phone 410-956-6800 · Fax 410-956-6803

Authorized official

Rosemary Ingado
Clinical Administrator
4109566800

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