Provider Demographics
| NPI: | 1629743034 |
|---|---|
| Name: | 1ST MEDICAL PAIN MANAGEMENT SPECIALISTS |
| Entity type: | Organization |
| Organization Name: | 1ST MEDICAL PAIN MANAGEMENT SPECIALISTS |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CLINICAL ADMINISTRATOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | ROSEMARY |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | INGADO |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | PHYSICIAN ASSISTANT |
| Authorized Official - Phone: | 410-956-6800 |
| Mailing Address - Street 1: | 831 UNIVERSITY BLVD E STE 34 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SILVER SPRING |
| Mailing Address - State: | MD |
| Mailing Address - Zip Code: | 20903-2915 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 301-408-2720 |
| Mailing Address - Fax: | 301-408-4503 |
| Practice Address - Street 1: | 831 UNIVERSITY BLVD E STE 34 |
| Practice Address - Street 2: | |
| Practice Address - City: | SILVER SPRING |
| Practice Address - State: | MD |
| Practice Address - Zip Code: | 20903-2915 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 301-408-2720 |
| Practice Address - Fax: | 301-408-2725 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | 1ST MEDICAL OF ANNAPOLIS, INC. |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2021-08-09 |
| Last Update Date: | 2022-01-23 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 225C00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | Group - Multi-Specialty | |
| No | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Multi-Specialty |
| No | 261QR0401X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
