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	D0068884	MD

General Provider Information

NPI Number	:	1225588676
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	:	7106 RIDGE RD STE 100
Second Line	:
City	:	ROSEDALE
State	:	MD
Zip	:	21237-3876
Country	:	US
Telephone Number	:	240-786-1001
Fax Number	:	240-786-1002

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	TRISTAN J SHOCKLEY
Credential	:	MD
Telephone Number	:	240-786-1001

Provider Enumeration Date	:	10/10/2016
Last Update Date	:	06/19/2021

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