Provider Demographics
NPI:1942777651
Name:MARYLAND PAIN AND WELLNESS CENTER
Entity Type:Organization
Organization Name:MARYLAND PAIN AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHAMPONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-392-7703
Mailing Address - Street 1:2200 DEFENSE HWY
Mailing Address - Street 2:STU 203
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114
Mailing Address - Country:US
Mailing Address - Phone:973-392-7703
Mailing Address - Fax:
Practice Address - Street 1:2200 DEFENSE HWY
Practice Address - Street 2:STU 203
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114
Practice Address - Country:US
Practice Address - Phone:973-392-7703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory