Provider Demographics
NPI:1750654794
Name:PHYSICAL MEDICINE ASSOCIATES LTD
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE ASSOCIATES LTD
Other - Org Name:NATIONAL SPINE & PAIN CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAYO
Authorized Official - Middle Name:F
Authorized Official - Last Name:FRIEDLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-914-8000
Mailing Address - Street 1:3031 JAVIER RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4637
Mailing Address - Country:US
Mailing Address - Phone:703-914-8000
Mailing Address - Fax:703-642-1876
Practice Address - Street 1:411B PARK HILL DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3376
Practice Address - Country:US
Practice Address - Phone:540-368-3917
Practice Address - Fax:540-372-9473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6688740005Medicare NSC