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General NPI Number Information
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NPI Number | 1871899880
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Entity Type | Organization
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Legal Business Name | PREMIER PAIN MANAGEMENT
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Dates
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Enumeration Date | 02/09/2011
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Last Update Date | 02/09/2011
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Provider Practice Location Address
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Address Line | 757 FREDERICK RD SUITE 100
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City | CATONSVILLE
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State | MD
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Zip | 21228-4500
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Country | US
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Telephone | 856-275-4388
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Fax | 215-748-5902
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Provider Business Mailing Address
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Address Line | 757 FREDERICK RD SUITE 100
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City | CATONSVILLE
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State | MD
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Zip | 21228-4500
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Country | US
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Telephone | 856-275-4388
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Fax | 215-748-5902
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. TONY T AL-AMIN
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Credential | M.D.
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Telephone | 856-275-4388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D0068116
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License Number State | MD
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