Provider Demographics
NPI:1811039449
Name:OCEAN STATE PAIN MANAGEMENT PC
Entity Type:Organization
Organization Name:OCEAN STATE PAIN MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARAKAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-333-6100
Mailing Address - Street 1:219 CASS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-4741
Mailing Address - Country:US
Mailing Address - Phone:401-766-1600
Mailing Address - Fax:401-766-1700
Practice Address - Street 1:219 CASS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4741
Practice Address - Country:US
Practice Address - Phone:401-333-6100
Practice Address - Fax:401-333-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
007056609Medicare UPIN