Provider Demographics
NPI:1790824563
Name:GLENN S. PRICE, MD PC
Entity Type:Organization
Organization Name:GLENN S. PRICE, MD PC
Other - Org Name:THE PAIN MANAGEMENT GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-764-1974
Mailing Address - Street 1:3306 FALLSTAFF RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-1723
Mailing Address - Country:US
Mailing Address - Phone:410-764-1974
Mailing Address - Fax:410-764-1974
Practice Address - Street 1:7850 ROSSVILLE BLVD STE 220
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-3934
Practice Address - Country:US
Practice Address - Phone:410-764-1974
Practice Address - Fax:866-556-5704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD090351500Medicaid
MD090351500Medicaid