Healthcare Provider Details

I. General information

NPI: 1467683128
Provider Name (Legal Business Name): OLNEY PAIN CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3413 OLANDWOOD CT STE 103
OLNEY MD
20832-1489
US

IV. Provider business mailing address

3413 OLANDWOOD CT STE 103
OLNEY MD
20832-1489
US

V. Phone/Fax

Practice location:
  • Phone: 301-774-1622
  • Fax: 301-774-0488
Mailing address:
  • Phone: 301-774-1622
  • Fax: 301-774-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberD0059441
License Number StateMD

VIII. Authorized Official

Name: DR. JONATHAN LEVIN
Title or Position: PRINCIPAL/OWNER
Credential: MD
Phone: 301-570-1862