MEDICARE: PAIN RELIEF SPECIALISTS - UPPER MARLBORO

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	208VP0000X	Pain Medicine Physician

General Provider Information

NPI Number	:	1942972815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN RELIEF SPECIALISTS - UPPER MARLBORO

Provider Business Mailing Address
First Line	:	9658 MARLBORO PIKE
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-3767
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9658 MARLBORO PIKE
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-3767
Country	:	US
Telephone Number	:	301-676-6922
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	GLORIA CORBIN
Credential	:
Telephone Number	:	240-357-1959

Provider Enumeration Date	:	09/29/2021
Last Update Date	:	09/29/2021

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