Organization · NPI-2

1st Medical Pain Management Specialists

Clinic/Center, Adult Mental Health · Catonsville, MD

NPI number1346915758

StatusActive

Last updated in NPPESJan 23, 2022

Details

NPI: 1346915758
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
261QM0850X	Clinic/Center, Adult Mental Health	–	–	Yes
101YA0400X	Counselor, Addiction (Substance Use Disorder)	–	–
101YM0800X	Counselor, Mental Health	–	–
1041C0700X	Social Worker, Clinical	–	–
261QM1300X	Clinic/Center, Multi-Specialty	–	–
261QR0400X	Clinic/Center, Rehabilitation	–	–
261QR0401X	Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)	–	–
261QR0405X	Clinic/Center, Rehabilitation, Substance Use Disorder	–	–
363LP0808X	Nurse Practitioner, Psych/Mental Health	–	–

Other names

1st Medical Painrehab Center (Doing Business As)

Practice location

405 Frederick Rd Ste 201
Catonsville, MD 21228-4645

Phone 410-788-4411 · Fax 410-788-4545

Mailing address

405 Frederick Rd Ste 11
Catonsville, MD 21228-4607

Phone 410-788-4411 · Fax 410-788-4545

Authorized official

Rosemary Ingado
Clinical Administrator
4109566800

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