MEDICARE: NOVA INTERVENTIONAL 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	D0060705	MD

General Provider Information

NPI Number	:	1821124215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA INTERVENTIONAL PAIN MANAGEMENT

Provider Business Mailing Address
First Line	:	PO BOX 489
Second Line	:
City	:	CHURCHVILLE
State	:	MD
Zip	:	21028-0489
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1952 PULASKI HWY
Second Line	:	SUITE B
City	:	EDGEWOOD
State	:	MD
Zip	:	21040-1617
Country	:	US
Telephone Number	:	410-676-1463
Fax Number	:	410-676-0864

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	LINDA MARTINDALE
Credential	:
Telephone Number	:	443-356-5968

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	10/11/2024

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