Provider Demographics
NPI:1205224300
Name:PHYSICAL MEDICINE ASSOCIATES, LTD
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE ASSOCIATES, LTD
Other - Org Name:NATIONAL SPINE AND PAIN CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
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, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1002
Mailing Address - Country:US
Mailing Address - Phone:410-329-1071
Mailing Address - Fax:410-329-1059
Practice Address - Street 1:1741 WILLIAMSPORT PIKE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-4341
Practice Address - Country:US
Practice Address - Phone:304-569-2378
Practice Address - Fax:304-596-2388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-26
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6688740020Medicare NSC