Provider Demographics
NPI:1851582563
Name:THE CARLE CENTER FOR PAIN MANAGEMENT,LLC
Entity Type:Organization
Organization Name:THE CARLE CENTER FOR PAIN MANAGEMENT,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH CARLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-337-2676
Mailing Address - Street 1:7600 OSLER DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7735
Mailing Address - Country:US
Mailing Address - Phone:410-337-2676
Mailing Address - Fax:
Practice Address - Street 1:7600 OSLER DR
Practice Address - Street 2:SUITE 205
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7735
Practice Address - Country:US
Practice Address - Phone:410-337-2676
Practice Address - Fax:410-337-2674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0042164174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE48559Medicare UPIN