Provider Demographics
NPI:1033665450
Name:MATSUNAGA PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:MATSUNAGA PAIN MANAGEMENT LLC
Other - Org Name:INNOVATIVE HEALTH LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KARTISEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-371-7749
Mailing Address - Street 1:8894 STANFORD BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4794
Mailing Address - Country:US
Mailing Address - Phone:410-997-7246
Mailing Address - Fax:410-997-7226
Practice Address - Street 1:9755 PATUXENT WOODS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2286
Practice Address - Country:US
Practice Address - Phone:410-218-3458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21D2117103291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory