Provider Demographics
NPI:1811724321
Name:1ST MEDICAL PAIN MANAGEMENT SPECIALISTS
Entity type:Organization
Organization Name:1ST MEDICAL PAIN MANAGEMENT SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:INGADO
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:410-956-6800
Mailing Address - Street 1:20 MAYO RD STE 201
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-1442
Mailing Address - Country:US
Mailing Address - Phone:410-956-6800
Mailing Address - Fax:410-956-6803
Practice Address - Street 1:20 MAYO RD STE 201
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-1442
Practice Address - Country:US
Practice Address - Phone:410-956-6800
Practice Address - Fax:410-956-6803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care