Provider Demographics
NPI:1295983997
Name:QOL PAIN MANAGEMENT LLC.
Entity type:Organization
Organization Name:QOL PAIN MANAGEMENT LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOGIST/PAIN MANAGEMENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:SINCLAIR
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-578-0730
Mailing Address - Street 1:701 BROOKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-1404
Mailing Address - Country:US
Mailing Address - Phone:410-947-8442
Mailing Address - Fax:410-578-0798
Practice Address - Street 1:3102 N HILTON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-1450
Practice Address - Country:US
Practice Address - Phone:410-578-0730
Practice Address - Fax:410-578-0798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0042216261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD345911000Medicaid
MD345911000Medicaid