Healthcare Provider Details

I. General information

NPI: 1821785163
Provider Name (Legal Business Name): INTERVENTIONAL PAIN INSTITUTE LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11623 PHILADELPHIA RD
WHITE MARSH MD
21162-1310
US

IV. Provider business mailing address

11623 PHILADELPHIA RD
WHITE MARSH MD
21162-1310
US

V. Phone/Fax

Practice location:
  • Phone: 443-599-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MANEESH SHARMA
Title or Position: OWNER
Credential:
Phone: 443-599-4000