MEDICARE: GREATER MARYLAND PAIN MANAGEMENT, 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	:	1437006145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER MARYLAND PAIN MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	1130 ANNAPOLIS RD STE 100
Second Line	:
City	:	ODENTON
State	:	MD
Zip	:	21113-1622
Country	:	US
Telephone Number	:	410-672-2255
Fax Number	:	410-672-2275

Provider Business Practice Location Address
First Line	:	6220 OLD DOBBIN LN STE 200
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-5813
Country	:	US
Telephone Number	:	410-672-2255
Fax Number	:	410-672-2275

Authorized Official
Title or Position	:	CEO
Name	:	JANAK A VIDYARTHI
Credential	:	MD
Telephone Number	:	410-672-2255

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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