MEDICARE: PAIN MANAGEMENT.BZ, 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	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1356353759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN MANAGEMENT.BZ, LLC

Provider Business Mailing Address
First Line	:	3 NASHUA CT
Second Line	:	SUITE H
City	:	BALTIMORE
State	:	MD
Zip	:	21221-3133
Country	:	US
Telephone Number	:	410-933-8494
Fax Number	:	410-933-3940

Provider Business Practice Location Address
First Line	:	2953 EMMORTON RD
Second Line	:
City	:	ABINGDON
State	:	MD
Zip	:	21009-1631
Country	:	US
Telephone Number	:	410-515-3518
Fax Number	:	410-515-6757

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LAWRENCE MICHAEL YALICH
Credential	:	DC
Telephone Number	:	410-933-8494

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	08/22/2020

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