Organization · NPI-2

Providence Pain Management Center, PA

Anesthesiology, Pain Medicine · Laurel, MD

NPI number1346708492
StatusActive
Last updated in NPPESOct 22, 2019

Details

NPI
1346708492
Entity type
Organization (NPI-2)
Legal business name
Providence Pain Management Center, PA
Organization subpart
Yes
Enumeration date
Mar 7, 2019
Last updated
Oct 22, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207LP2900X Anesthesiology, Pain Medicine––Yes

Practice location

14201 Laurel Park Dr
Suite 223
Laurel, MD 20707

Phone 301-798-9300 · Fax 301-355-2101

Mailing address

6911 Laurel Bowie Rd
Suite 212
Bowie, MD 20721

Phone 301-750-9500

Authorized official

Akara Forsythe
Ceo
3017509500

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