Provider Demographics
NPI:1134494891
Name:PHYSICAL MEDICINE ASSOCIATES LTD
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE ASSOCIATES LTD
Other - Org Name:NATIONAL SPINE & PAIN CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAYO
Authorized Official - Middle Name:F
Authorized Official - Last Name:FRIEDLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-914-8000
Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EXECUTIVE PLAZA 1, STE. 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031
Mailing Address - Country:US
Mailing Address - Phone:410-329-1071
Mailing Address - Fax:410-329-1054
Practice Address - Street 1:11350 MCCORMICK RD
Practice Address - Street 2:EXECUTIVE PLAZA 1, STE. 501
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031
Practice Address - Country:US
Practice Address - Phone:410-329-1071
Practice Address - Fax:410-329-1054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6688740011Medicare NSC