Healthcare Provider Details

I. General information

NPI: 1891152096
Provider Name (Legal Business Name): CHOICE PAIN & REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9841 GREENBELT RD SUITE 208
LANHAM MD
20706
US

IV. Provider business mailing address

9900 GREENBELT ROAD SUITE E117
LANHAM MD
20706-0605
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 Code291U00000X
TaxonomyClinical Medical Laboratory
License Number150108
License Number StateMD

VIII. Authorized Official

Name: DR. TRISTAN J SHOCKLEY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 202-489-1125