=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801788740
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY OF MARYLAND ST. JOSEPH PAIN SPECIALISTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2025
-----------------------------------------------------
Last Update Date | 07/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 226 SCHILLING CIR STE 170
-----------------------------------------------------
City | HUNT VALLEY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21031-8641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 667-214-2525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 ELKRIDGE LANDING RD FL 2
-----------------------------------------------------
City | LINTHICUM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21090-2924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AO
-----------------------------------------------------
Name | LAURA DOODY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-337-1602
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------