Provider Demographics
NPI:1558359661
Name:PHYSICAL MEDICINE & PAIN MANAGEMENT ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE & PAIN MANAGEMENT ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-266-2711
Mailing Address - Street 1:2002 MEDICAL PKWY
Mailing Address - Street 2:SUITE 430
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3046
Mailing Address - Country:US
Mailing Address - Phone:410-266-2700
Mailing Address - Fax:410-269-1149
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE 430
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-266-2700
Practice Address - Fax:410-269-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2300143OtherAMERICHOICE UHC
MD119602201Medicaid
C475OtherCAREFIRST NATIONAL CAP AR
147028800OtherDEPT. OF LABOR
MD4555195OtherAETNA
MD111437OtherKAISER HEALTH PLAN
MDCN4381OtherRAILROAD MEDICARE
MDKQ86PAMedicare ID - Type UnspecifiedTRAILBLAZER MEDICARE