Healthcare Provider Details

I. General information

NPI: 1336472356
Provider Name (Legal Business Name): GEORGETOWN PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 HANOVER DR SUITE 204
GREENBELT MD
20770-2202
US

IV. Provider business mailing address

7300 HANOVER DR SUITE 204
GREENBELT MD
20770-2202
US

V. Phone/Fax

Practice location:
  • Phone: 301-220-2333
  • Fax: 301-220-2339
Mailing address:
  • Phone: 301-220-2333
  • Fax: 301-220-2339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: NETSERE TESFAYOHANNES
Title or Position: MANAGING PHYSICIAN
Credential: MD
Phone: 301-220-2333