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General NPI Number Information
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NPI Number | 1346708492
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Entity Type | Organization
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Legal Business Name | PROVIDENCE PAIN MANAGEMENT CENTER, PA
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Dates
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Enumeration Date | 03/07/2019
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Last Update Date | 10/22/2019
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Provider Practice Location Address
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Address Line | 14201 LAUREL PARK DR SUITE 223
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City | LAUREL
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State | MD
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Zip | 20707
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Country | US
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Telephone | 301-798-9300
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Fax | 301-355-2101
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Provider Business Mailing Address
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Address Line | 6911 LAUREL BOWIE RD SUITE 212
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City | BOWIE
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State | MD
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Zip | 20721
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Country | US
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Telephone | 301-750-9500
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AKARA FORSYTHE
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Credential | MD
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Telephone | 301-750-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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