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General NPI Number Information
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NPI Number | 1992259576
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Entity Type | Organization
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Legal Business Name | PURE PAIN PRACTICE LLC
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Dates
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Enumeration Date | 08/11/2016
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Last Update Date | 09/06/2016
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Provider Practice Location Address
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Address Line | 8895 CENTRE PARK DR SUITE E
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City | COLUMBIA
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State | MD
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Zip | 21045-1966
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Country | US
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Telephone | 585-713-9935
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Fax |
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Provider Business Mailing Address
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Address Line | 8895 CENTRE PARK DR SUITE E
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City | COLUMBIA
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State | MD
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Zip | 21045-1966
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Country | US
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Telephone | 585-713-9935
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. SUKHBIR SINGH BHURJI
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Credential | PA-C
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Telephone | 585-713-9935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | C0005282
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License Number State | MD
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