Healthcare Provider Details

I. General information

NPI: 1447617238
Provider Name (Legal Business Name): PAIN DOCTORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 BELAIR RD SUITE A
BALTIMORE MD
21206-6300
US

IV. Provider business mailing address

4300 BELAIR RD SUITE A
BALTIMORE MD
21206-6300
US

V. Phone/Fax

Practice location:
  • Phone: 443-768-8758
  • Fax:
Mailing address:
  • Phone: 410-325-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MIKE BURDMAN
Title or Position: PARTNER
Credential: DC
Phone: 443-768-8758