Provider Demographics
NPI:1306210521
Name:WHITE MARSH HEALTHCARE & PHYSICAL MEDICINE,LLC
Entity Type:Organization
Organization Name:WHITE MARSH HEALTHCARE & PHYSICAL MEDICINE,LLC
Other - Org Name:BALTIMORE PAIN RELIEF CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:T
Authorized Official - Middle Name:
Authorized Official - Last Name:GOBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:443-725-4930
Mailing Address - Street 1:5430 CAMPBELL BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-5500
Mailing Address - Country:US
Mailing Address - Phone:443-725-4930
Mailing Address - Fax:410-657-7478
Practice Address - Street 1:4552 EDMONDSON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-1506
Practice Address - Country:US
Practice Address - Phone:443-725-4930
Practice Address - Fax:667-212-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-27
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty