Healthcare Provider Details

I. General information

NPI: 1578282471
Provider Name (Legal Business Name): METROPOLITAN PAIN PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 OLD ANNAPOLIS RD STE 305
ELLICOTT CITY MD
21042-6337
US

IV. Provider business mailing address

9501 OLD ANNAPOLIS RD STE 305
ELLICOTT CITY MD
21042-6337
US

V. Phone/Fax

Practice location:
  • Phone: 301-490-6698
  • Fax:
Mailing address:
  • Phone: 301-490-6698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEVI PEARSON
Title or Position: OWNER
Credential: MD
Phone: 443-367-0011