Healthcare Provider Details

I. General information

NPI: 1639554835
Provider Name (Legal Business Name): SMART PAIN MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 BENSON AVE SUITE 210
BALTIMORE MD
21227-1056
US

IV. Provider business mailing address

2 PARK CENTER CT SUITE 200
OWINGS MILLS MD
21117-4295
US

V. Phone/Fax

Practice location:
  • Phone: 443-693-7246
  • Fax: 443-388-8075
Mailing address:
  • Phone: 443-693-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: IRA KORNBLUTH
Title or Position: CEO
Credential: M.D.
Phone: 443-693-7246