Healthcare Provider Details

I. General information

NPI: 1053259648
Provider Name (Legal Business Name): IDEAL PAIN MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 GOVERNOR RITCHIE HWY STE K
SEVERNA PARK MD
21146-2953
US

IV. Provider business mailing address

217 E CHURCHVILLE RD
BEL AIR MD
21014-3825
US

V. Phone/Fax

Practice location:
  • Phone: 703-522-2727
  • Fax: 703-542-3753
Mailing address:
  • Phone: 703-522-2727
  • Fax: 703-542-3753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA PAPENFUHS
Title or Position: BILLING MANAGER
Credential:
Phone: 703-522-2727