1588115554 NPI number — CHOICE PAIN AND REHABILITATION CENTER

Table of content: (NPI 1588115554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588115554 NPI number — CHOICE PAIN AND REHABILITATION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHOICE PAIN AND REHABILITATION CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHOICE PAIN AND REHABILITATION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588115554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9900 GREENBELT RD
Provider Second Line Business Mailing Address:
SUITE E117
Provider Business Mailing Address City Name:
LANHAM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20706-2255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-780-1001
Provider Business Mailing Address Fax Number:
240-786-1002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 MARTIN LUTHER KING JR BLVD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-1221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-786-1001
Provider Business Practice Location Address Fax Number:
240-786-1002
Provider Enumeration Date:
10/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SHOCKLEY
Authorized Official First Name:
TRISTAN
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
240-786-1001

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  D0068884 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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