Healthcare Provider Details

I. General information

NPI: 1184971509
Provider Name (Legal Business Name): CHRONIC PAIN TREATMENT CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8435 PROGRESS DR STE EE
FREDERICK MD
21701-4981
US

IV. Provider business mailing address

8435 PROGRESS DR STE EE
FREDERICK MD
21701-4981
US

V. Phone/Fax

Practice location:
  • Phone: 301-624-5390
  • Fax: 301-624-5393
Mailing address:
  • Phone: 301-624-5390
  • Fax: 301-624-5393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number10554640
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GLORIA CORBIN
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 301-732-6300