Healthcare Provider Details

I. General information

NPI: 1871043190
Provider Name (Legal Business Name): CHOICE PAIN & REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 06/19/2021
Certification Date: 06/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18540 OFFICE PARK DR
MONTGOMERY VILLAGE MD
20886-0586
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: 240-786-1002
Mailing address:
  • Phone: 240-786-1001
  • Fax: 240-786-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberD0068884
License Number StateMD

VIII. Authorized Official

Name: TRISTAN J SHOCKLEY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 240-786-1001