Provider Demographics
NPI:1538301494
Name:PAIN MANAGEMENT ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PAIN MANAGEMENT ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HADDIS
Authorized Official - Middle Name:T
Authorized Official - Last Name:HAGOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-220-2333
Mailing Address - Street 1:7300 HANOVER DR # 204
Mailing Address - Street 2:
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 # 204
Practice Address - Street 2:
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:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400891001Medicaid
MD400891001Medicaid