MEDICARE: PMREHAB PAIN AND SPORTS MEDICINE ASSOCIATES

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	D56237	MD

General Provider Information

NPI Number	:	1144356353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PMREHAB PAIN AND SPORTS MEDICINE ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 710080
Second Line	:
City	:	HERNDON
State	:	VA
Zip	:	20171-0080
Country	:	US
Telephone Number	:	301-218-2000
Fax Number	:	301-218-5016

Provider Business Practice Location Address
First Line	:	3048 MITCHELLVILLE RD
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20716-1388
Country	:	US
Telephone Number	:	301-218-2000
Fax Number	:	301-218-5016

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. SEGUN TOYIN DAWODU
Credential	:	MD
Telephone Number	:	301-218-2000

Provider Enumeration Date	:	02/24/2007
Last Update Date	:	06/19/2008

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