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General NPI Number Information
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NPI Number | 1487837886
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT ASSOCIATES
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 02/08/2008
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Provider Practice Location Address
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Address Line | 4000 MITCHELLVILLE RD. SUITE B 116
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City | BOWIE
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State | MD
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Zip | 20716
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Country | US
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Telephone | 301-464-5575
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Fax | 301-805-9791
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Provider Business Mailing Address
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Address Line | 3247 ELEANORS GARDEN WAY
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City | WOODBINE
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State | MD
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Zip | 21797-7508
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Country | US
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Telephone | 301-704-0681
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Fax | 301-805-9791
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Authorized Official
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Title or Position | PRSIDENT
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Name | DR. HADDIS T HAGOS
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Credential | M.D.
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Telephone | 301-464-5575
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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 | D0059481
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License Number State | MD
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