Provider Demographics
NPI:1336472356
Name:GEORGETOWN PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:GEORGETOWN PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NETSERE
Authorized Official - Middle Name:
Authorized Official - Last Name:TESFAYOHANNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-220-2333
Mailing Address - Street 1:7300 HANOVER DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2202
Mailing Address - Country:US
Mailing Address - Phone:301-220-2333
Mailing Address - Fax:301-220-2339
Practice Address - Street 1:7300 HANOVER DR
Practice Address - Street 2:SUITE 204
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2202
Practice Address - Country:US
Practice Address - Phone:301-220-2333
Practice Address - Fax:301-220-2339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty