Healthcare Provider Details

I. General information

NPI: 1528803863
Provider Name (Legal Business Name): TOTAL PAIN CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3306 LAUREL HILL RD
HANOVER MD
21076-2254
US

IV. Provider business mailing address

3306 LAUREL HILL RD
HANOVER MD
21076-2254
US

V. Phone/Fax

Practice location:
  • Phone: 410-302-9464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JACOB HA
Title or Position: OWNER/CEO
Credential:
Phone: 410-401-7575