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General NPI Number Information
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NPI Number | 1407184872
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Entity Type | Organization
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Legal Business Name | ATLANTIC INTERVENTIONAL PAIN MANAGEMENT
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 02/05/2010
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Provider Practice Location Address
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Address Line | 8109 RITCHIE HWY
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City | PASADENA
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State | MD
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Zip | 21122-6917
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Country | US
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Telephone | 410-382-3013
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Fax | 410-590-8839
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Provider Business Mailing Address
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Address Line | 1424 ILLINOIS AVE
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City | SEVERN
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State | MD
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Zip | 21144-2643
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Country | US
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Telephone | 410-382-3013
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Fax | 410-590-8839
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Authorized Official
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Title or Position | SOLE MANAGER
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Name | HADDIJATOU SECKA OGUNSOLA
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Credential | M.D.
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Telephone | 410-382-3013
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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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