Provider Demographics
NPI:1225588676
Name:CHOICE PAIN & REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:CHOICE PAIN & REHABILITATION CENTER, LLC
Other - Org Name:CHOICE PAIN & REHABILITATION CENTER, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRISTAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHOCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-786-1001
Mailing Address - Street 1:8843 GREENBELT RD STE 117
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2451
Mailing Address - Country:US
Mailing Address - Phone:240-786-1001
Mailing Address - Fax:240-786-1002
Practice Address - Street 1:7106 RIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-3876
Practice Address - Country:US
Practice Address - Phone:240-786-1001
Practice Address - Fax:240-786-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00688842081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD299001Medicare PIN