Healthcare Provider Details

I. General information

NPI: 1568601656
Provider Name (Legal Business Name): WASHINGTON METRO PAIN INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 HANOVER DRIVE # 204
GREENBELT MD
20770
US

IV. Provider business mailing address

7300 HANOVER DRIVE # 204
GREENBELT MD
20770
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 TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberD0059481
License Number StateMD

VIII. Authorized Official

Name: HADDIS T HAGOS
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 301-220-2333