Provider Demographics
NPI:1811784911
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:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTOSH
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:410-672-2255
Mailing Address - Fax:410-816-9472
Practice Address - Street 1:110 HOSPITAL RD STE 214
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4040
Practice Address - Country:US
Practice Address - Phone:410-672-2555
Practice Address - Fax:410-816-9472
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREATER MARYLAND PAIN MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty