Healthcare Provider Details

I. General information

NPI: 1336798388
Provider Name (Legal Business Name): GLOBAL PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 COLUMBIA 100 PARKWAY SUITE C
COLUMBIA MD
21045-7346
US

IV. Provider business mailing address

8900 COLUMBIA 100 PARKWAY SUITE C
COLUMBIA MD
21045-7346
US

V. Phone/Fax

Practice location:
  • Phone: 443-825-4051
  • Fax:
Mailing address:
  • Phone: 443-825-4051
  • Fax:

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: HADDITOUTOU OGUNSOLA
Title or Position: CEO
Credential: MD
Phone: 443-825-4051