MEDICARE: GREATER MARYLAND PAIN MANAGEMENT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1811784911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER MARYLAND PAIN MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	1130 ANNAPOLIS RD STE 100
Second Line	:
City	:	ODENTON
State	:	MD
Zip	:	21113-1622
Country	:	US
Telephone Number	:	410-672-2255
Fax Number	:	410-816-9472

Provider Business Practice Location Address
First Line	:	301 STEEPLE CHASE DR STE 103
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-4050
Country	:	US
Telephone Number	:	410-672-2555
Fax Number	:	410-672-2275

Authorized Official
Title or Position	:	CEO
Name	:	JANAK A VIDYARTHI
Credential	:
Telephone Number	:	410-672-2255

Provider Enumeration Date	:	04/22/2025
Last Update Date	:	02/06/2026

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