Provider Demographics
NPI:1750592838
Name:SOLACE PAIN MANAGEMENT & REHABILITATION LLC
Entity type:Organization
Organization Name:SOLACE PAIN MANAGEMENT & REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:RUIJIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-251-5700
Mailing Address - Street 1:14816 PHYSICIANS LN STE 151
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3937
Mailing Address - Country:US
Mailing Address - Phone:301-251-5700
Mailing Address - Fax:301-251-5719
Practice Address - Street 1:14816 PHYSICIANS LN STE 151
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3937
Practice Address - Country:US
Practice Address - Phone:301-251-5700
Practice Address - Fax:301-251-5719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD59782174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405184000Medicaid
MDG01444Medicare PIN
MDH28976Medicare UPIN
MD405184000Medicaid