Provider Demographics
NPI:1891575411
Name:SUPERB PAIN MANAGEMENT CENTER
Entity Type:Organization
Organization Name:SUPERB PAIN MANAGEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALDANE
Authorized Official - Middle Name:ELEONU
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:443-613-7391
Mailing Address - Street 1:7615 PERRING TER
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-6120
Mailing Address - Country:US
Mailing Address - Phone:443-613-7391
Mailing Address - Fax:410-337-2674
Practice Address - Street 1:7600 OSLER DR STE 205
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7701
Practice Address - Country:US
Practice Address - Phone:443-613-7391
Practice Address - Fax:410-337-2674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service