Healthcare Provider Details

I. General information

NPI: 1700630472
Provider Name (Legal Business Name): NOVUS PAIN MANAGEMENT - MARYLAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E 33RD ST
BALTIMORE MD
21218-3780
US

IV. Provider business mailing address

157 BALTIMORE ST
CUMBERLAND MD
21502-2472
US

V. Phone/Fax

Practice location:
  • Phone: 301-722-0484
  • Fax: 833-903-0130
Mailing address:
  • Phone: 301-722-0484
  • Fax: 833-903-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: HEATHER ROBOSSON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 240-727-3995