Provider Demographics
NPI:1306213186
Name:MATSUNAGA PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:MATSUNAGA PAIN MANAGEMENT LLC
Other - Org Name:COMPREHENSIVE PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:MATSUNAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-997-7246
Mailing Address - Street 1:8894 STANFORD BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4794
Mailing Address - Country:US
Mailing Address - Phone:410-997-7246
Mailing Address - Fax:410-997-7226
Practice Address - Street 1:8894 STANFORD BLVD.
Practice Address - Street 2:SUITE 104
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5161
Practice Address - Country:US
Practice Address - Phone:410-997-7246
Practice Address - Fax:410-997-7226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037907207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF01017Medicare UPIN
MD312PMedicare PIN