Healthcare Provider Details

I. General information

NPI: 1568809598
Provider Name (Legal Business Name): CHOICE PAIN & REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7404 EXECUTIVE PL STE 503
LANHAM MD
20706-2268
US

IV. Provider business mailing address

8843 GREENBELT RD STE 117
GREENBELT MD
20770-2451
US

V. Phone/Fax

Practice location:
  • Phone: 240-786-1001
  • Fax:
Mailing address:
  • Phone: 240-786-1001
  • Fax: 240-786-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TRISTAN JULIAN SHOCKLEY
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 240-786-1001