Healthcare Provider Details

I. General information

NPI: 1306485925
Provider Name (Legal Business Name): PAIN MANAGEMENT PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 W MAIN ST UNIT 5
WATERBURY CT
06708-3119
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 203-770-5574
  • Fax:
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: DO
Phone: 203-885-1441