Provider Demographics
NPI:1770343964
Name:GREATER MARYLAND PAIN MANAGEMENT, LLC
Entity type:Organization
Organization Name:GREATER MARYLAND PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANAK
Authorized Official - Middle Name:A
Authorized Official - Last Name:VIDYARTHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-672-2255
Mailing Address - Street 1:1130 ANNAPOLIS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1622
Mailing Address - Country:US
Mailing Address - Phone:703-347-1962
Mailing Address - Fax:
Practice Address - Street 1:7845 OAKWOOD RD STE 201
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4257
Practice Address - Country:US
Practice Address - Phone:410-672-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty