Provider Demographics
NPI:1447617238
Name:PAIN DOCTORS
Entity Type:Organization
Organization Name:PAIN DOCTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:443-768-8758
Mailing Address - Street 1:4300 BELAIR RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-6300
Mailing Address - Country:US
Mailing Address - Phone:410-325-7246
Mailing Address - Fax:
Practice Address - Street 1:4300 BELAIR RD
Practice Address - Street 2:SUITE A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-6300
Practice Address - Country:US
Practice Address - Phone:443-768-8758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0116572 00Medicaid
MD528855OtherMEDICARE GROUP
MD0116572 00Medicaid