Provider Demographics
NPI:1467683128
Name:OLNEY PAIN CENTER LLC
Entity Type:Organization
Organization Name:OLNEY PAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-570-1862
Mailing Address - Street 1:3413 OLANDWOOD CT
Mailing Address - Street 2:STE 103
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1489
Mailing Address - Country:US
Mailing Address - Phone:301-774-1622
Mailing Address - Fax:301-774-0488
Practice Address - Street 1:3413 OLANDWOOD CT
Practice Address - Street 2:STE 103
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1489
Practice Address - Country:US
Practice Address - Phone:301-774-1622
Practice Address - Fax:301-774-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00594412081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty