Provider Demographics
NPI:1184665069
Name:DECK PAIN MANAGEMENT , LLC
Entity Type:Organization
Organization Name:DECK PAIN MANAGEMENT , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:LOEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-881-7246
Mailing Address - Street 1:11921 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2737
Mailing Address - Country:US
Mailing Address - Phone:410-265-7300
Mailing Address - Fax:410-265-9533
Practice Address - Street 1:75 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE C
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4895
Practice Address - Country:US
Practice Address - Phone:301-620-0012
Practice Address - Fax:301-620-9687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD308CCEOtherBLUE CROSS
MDK907OtherBLUE CROSS
MDDE8894OtherRAILROAD MEDICARE
DCG02677Medicare PIN
MDDE8894OtherRAILROAD MEDICARE