Healthcare Provider Details

I. General information

NPI: 1164057568
Provider Name (Legal Business Name): PAIN MANAGEMENT PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 06/16/2022
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BIRDSEYE RD STE 260
FARMINGTON CT
06032-2489
US

IV. Provider business mailing address

7 OLD SHERMAN TPKE STE 209
DANBURY CT
06810-4174
US

V. Phone/Fax

Practice location:
  • Phone: 860-606-7557
  • Fax: 860-404-2334
Mailing address:
  • Phone: 203-885-1441
  • Fax: 475-329-2283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH ANN SPRAGUE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 203-885-1441