MEDICARE: GLOBAL PAIN MANAGEMENT

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

General Provider Information

NPI Number	:	1336798388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLOBAL PAIN MANAGEMENT

Provider Business Mailing Address
First Line	:	8900 COLUMBIA 100 PARKWAY
Second Line	:	SUITE C
City	:	COLUMBIA
State	:	MD
Zip	:	21045-7346
Country	:	US
Telephone Number	:	443-825-4051
Fax Number	:

Provider Business Practice Location Address
First Line	:	8900 COLUMBIA 100 PARKWAY
Second Line	:	SUITE C
City	:	COLUMBIA
State	:	MD
Zip	:	21045-7346
Country	:	US
Telephone Number	:	443-825-4051
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	HADDITOUTOU OGUNSOLA
Credential	:	MD
Telephone Number	:	443-825-4051

Provider Enumeration Date	:	09/11/2019
Last Update Date	:	09/11/2019

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