Healthcare Provider Details

I. General information

NPI: 1356389845
Provider Name (Legal Business Name): BALTIMORE PAIN MANAGEMENT CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9106 PHILADELPHIA RD STE 108
BALTIMORE MD
21237-4335
US

IV. Provider business mailing address

9106 PHILADELPHIA RD STE 108
BALTIMORE MD
21237-4335
US

V. Phone/Fax

Practice location:
  • Phone: 410-682-5040
  • Fax: 410-682-5044
Mailing address:
  • Phone: 410-682-5040
  • Fax: 410-682-5044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL A. GARDYN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 410-499-0082