Provider Demographics
NPI:1457575656
Name:PHYSICIAN OBJECTIVE EVALUATION AND MANAGEMENT
Entity Type:Organization
Organization Name:PHYSICIAN OBJECTIVE EVALUATION AND MANAGEMENT
Other - Org Name:SETON PAIN AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:A
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:410-644-8500
Mailing Address - Street 1:3350 WILKENS AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-4600
Mailing Address - Country:US
Mailing Address - Phone:410-644-8500
Mailing Address - Fax:410-644-8900
Practice Address - Street 1:3350 WILKENS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-4600
Practice Address - Country:US
Practice Address - Phone:410-644-8500
Practice Address - Fax:410-644-8900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIAN OBJECTIVE EVALUATION AND MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-12
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH00457952081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD40539400Medicaid
MD709MMedicare PIN
MD40539400Medicaid