Healthcare Provider Details

I. General information

NPI: 1174618342
Provider Name (Legal Business Name): MATSUNAGA PAIN MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8894 STANFORD BLVD STE 104
COLUMBIA MD
21045-5161
US

IV. Provider business mailing address

10710 CHARTER DR SUITE 240
COLUMBIA MD
21044-3128
US

V. Phone/Fax

Practice location:
  • Phone: 410-997-7246
  • Fax: 410-997-7226
Mailing address:
  • Phone: 410-997-7246
  • Fax: 410-997-7226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberD0037907
License Number StateMD

VIII. Authorized Official

Name: DR. MARK MATSUNAGA
Title or Position: OWNER
Credential: MD
Phone: 410-997-7246