Provider Demographics
NPI:1568702124
Name:BETHESDA PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:BETHESDA PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-770-7900
Mailing Address - Street 1:PO BOX 79794
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0794
Mailing Address - Country:US
Mailing Address - Phone:443-274-2900
Mailing Address - Fax:443-274-2391
Practice Address - Street 1:6000 EXECUTIVE BLVD
Practice Address - Street 2:510
Practice Address - City:N BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-3803
Practice Address - Country:US
Practice Address - Phone:301-770-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033495207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty