Provider Demographics
NPI:1235514472
Name:SMART PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:SMART PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNBLUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-693-7246
Mailing Address - Street 1:2 PARK CENTER CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4295
Mailing Address - Country:US
Mailing Address - Phone:443-693-7246
Mailing Address - Fax:
Practice Address - Street 1:1576 MERRITT BLVD
Practice Address - Street 2:SUITE 18
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-2132
Practice Address - Country:US
Practice Address - Phone:443-693-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7187550007Medicare PIN
MD1240056Medicaid