Healthcare Provider Details

I. General information

NPI: 1003744897
Provider Name (Legal Business Name): GREATER MARYLAND PAIN MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 SOLLERS POINT RD
DUNDALK MD
21222-4647
US

IV. Provider business mailing address

1130 ANNAPOLIS RD STE 100
ODENTON MD
21113-1622
US

V. Phone/Fax

Practice location:
  • Phone: 410-672-2255
  • Fax:
Mailing address:
  • Phone: 410-672-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JANAK A VIDYARTHI
Title or Position: CEO
Credential: MD
Phone: 410-672-2255