Organization · NPI-2

Providence Pain Management Center, P.A.

Clinical Medical Laboratory · Bowie, MD

NPI number1285121749
StatusActive
Last updated in NPPESAug 13, 2019

Details

NPI
1285121749
Entity type
Organization (NPI-2)
Legal business name
Providence Pain Management Center, P.A.
Organization subpart
No
Enumeration date
Apr 19, 2018
Last updated
Aug 13, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
291U00000X Clinical Medical Laboratory21D2142104MDYes

Other names

  • Innovative Laboratories (Doing Business As)

Practice location

6911 Laurel Bowie Rd Ste 212b
Bowie, MD 20715-1712

Phone 301-755-9500 · Fax 301-747-6017

Mailing address

6911 Laurel Bowie Rd Ste 212b
Bowie, MD 20715-1712

Phone 301-755-9500 · Fax 301-747-6017

Other practice locations

201 Pine Bluff Rd Ste 1
Salisbury, MD 21801-7163

Phone 410-648-2000 · Fax 410-946-8360

Authorized official

Joseph Maxwell Oppong
Ceo
3017509500

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