MEDICARE: CHOICE PAIN & REHABILITATION CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	D008884	MD

General Provider Information

NPI Number	:	1033505391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOICE PAIN & REHABILITATION CENTER, LLC

Provider Business Mailing Address
First Line	:	8843 GREENBELT RD STE 117
Second Line	:
City	:	GREENBELT
State	:	MD
Zip	:	20770-2451
Country	:	US
Telephone Number	:	240-786-1001
Fax Number	:	240-786-1002

Provider Business Practice Location Address
First Line	:	6475 NEW HAMPSHIRE AVE STE 620
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-3280
Country	:	US
Telephone Number	:	240-786-1001
Fax Number	:	240-786-1002

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. TRISTAN JULIUS SHOCKLEY
Credential	:	MD
Telephone Number	:	202-489-1100

Provider Enumeration Date	:	04/13/2015
Last Update Date	:	06/21/2021

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