Healthcare Provider Details

I. General information

NPI: 1740586627
Provider Name (Legal Business Name): INTERVENTIONAL PAIN INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 LIGHTHOUSE PT E SUITE 402
BALTIMORE MD
21224-4777
US

IV. Provider business mailing address

2700 LIGHTHOUSE PT E SUITE 402
BALTIMORE MD
21224-4777
US

V. Phone/Fax

Practice location:
  • Phone: 444-599-4000
  • Fax: 443-599-4012
Mailing address:
  • Phone: 444-599-4000
  • Fax: 443-599-4012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MANEESH C SHARMA
Title or Position: MEDICAL DIRECTOR-OWNER
Credential: MD
Phone: 443-599-4000