Provider Demographics
NPI:1700050937
Name:MID-ATLANTIC PAIN INSTITUTE PA
Entity Type:Organization
Organization Name:MID-ATLANTIC PAIN INSTITUTE PA
Other - Org Name:MID ATLANTIC SPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:FALCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-303-8987
Mailing Address - Street 1:100 BIDDLE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3981
Mailing Address - Country:US
Mailing Address - Phone:302-369-1700
Mailing Address - Fax:302-838-5360
Practice Address - Street 1:101 CHESAPEAKE BLVD STE B
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921
Practice Address - Country:US
Practice Address - Phone:443-303-8987
Practice Address - Fax:443-715-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD894202100Medicaid
MD894202100Medicaid
MD4168530004Medicare NSC