MARYLAND PAIN & REGENERATIVE CENTER, LLC (NPI# 1104467463) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1104467463 |
Entity Type | Organization |
Organization Name | MARYLAND PAIN & REGENERATIVE CENTER, LLC |
Other Organization Name | DOMINION SPINE AND PAIN |
Practice Address |
12070 Old Line Ctr Waldorf MD 20602-2513 |
Mailing Address |
2952 Bonds Ridge Ct Oakton VA 22124-1778 |
Practice Telephone | 5716335017 |
Mailing Telephone | 4198197394 |
Enumeration Date | 2019-10-07 |
Last Update Date | 2019-12-12 |
Authorized Official Name | ANUSH VARMA (PRACTICE MANAGER) |
Authorized Official Telephone | 4199024171 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
Allopathic & Osteopathic Physicians |
Other Name | Type Code |
---|---|
Dominion spine and pain | Doing Business As Name - Organization |
Street Address |
12070 OLD LINE CTR |
City | WALDORF |
State | MD |
Zip Code | 20602-2513 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1942206412 | Douglas Avery & Associates Ltd | Clinic/Center | 12070 Old Line Ctr, Ste 107, Waldorf, MD 20602-2503 | 2005-06-21 |
1578947305 | Larry S. Hotchkiss, Dpm PC | Non-Pharmacy Dispensing Site | 12070 Old Line Ctr, #110, Waldorf, MD 20602-2513 | 2015-07-10 |
1851791735 | Pro-perform Spinal Health & Rehab LLC | Chiropractor | 12070 Old Line Ctr, Suite 301, Waldorf, MD 20602-2513 | 2014-08-28 |
1427494343 | Denise Colton | Nurse Practitioner | 12070 Old Line Ctr, Suite 302, Waldorf, MD 20602-2513 | 2013-05-18 |
1659636082 | Justin G. Pointer | Podiatrist | 12070 Old Line Ctr, Suite 110, Waldorf, MD 20602-2513 | 2012-07-11 |
1538437223 | Christine T Gardella | Physician Assistant | 12070 Old Line Ctr, Suite 302, Waldorf, MD 20602-2513 | 2011-12-08 |
1265670046 | Dawn Stephanie Christopher | Internal Medicine | 12070 Old Line Ctr, Suite 303, Waldorf, MD 20602-2513 | 2009-02-02 |
1548406960 | Surgical Associates, Chartered | Surgery | 12070 Old Line Ctr, Suite 306, Waldorf, MD 20602-2513 | 2009-01-07 |
1386812113 | Elizabeth Hurt | Internal Medicine | 12070 Old Line Ctr, Suite 303, Waldorf, MD 20602-2513 | 2008-02-14 |
1861682957 | Gowri Kularatna | Internal Medicine | 12070 Old Line Ctr, Suite 200, Waldorf, MD 20602-2513 | 2007-07-26 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1053964957 | Haeyoung Choi | Pharmacist | 25 Smallwood Village Center, Waldorf, MD 20602 | 2019-07-19 |
1679137194 | Brighter Days Family Services Inc | Counselor | 11680 Doolittle Dr #111, Waldorf, MD 20602 | 2019-04-30 |
1396227039 | Lantern Family Services Inc | Community/Behavioral Health | 11680 Doolittle Dr Ste 111, Waldorf, MD 20602 | 2018-08-29 |
1093294910 | Metropolitan Vascular Institute LLC | Internal Medicine | 12070 Old Line Ctr Ste 100, Waldorf, MD 20602 | 2018-08-10 |
1174009922 | Dr. Arthur B. Sorkin, D.d.s., LLC | Dentist | 3460 Old Washington Rd., Suite 301-b, Waldorf, MD 20602 | 2018-07-16 |
1467945030 | Donna Marie Conley-shaw | Behavior Technician | 16 Pagnell Cir, Waldorf, MD 20602 | 2018-06-08 |
1811404296 | Loni Berbaum | Speech-Language Pathologist | 4817 Elmley Pl Apt 315, Waldorf, MD 20602 | 2018-01-06 |
1891224853 | Linda E Smith | Social Worker | 605 Pst Office Road, #301, Waldorf, MD 20602 | 2017-06-05 |
1104373273 | Love Ngum Che | Pharmacist | 25 Smallwood Village, Waldorf, MD 20602 | 2016-09-07 |
1639543341 | Matengy Toure | Pharmacist | 129 St Charles Pkwy, Waldorf, MD 20602 | 2015-11-18 |
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Taxonomy Code | 208VP0014X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Pain Medicine |
Specialization | Interventional Pain Medicine |
Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1942839162 | Physical Medicine Associates, Ltd | Pain Medicine | 3460 Old Washington Rd Ste 300, Waldorf, MD 20602-3245 | 2020-04-08 |
1437458809 | Center for Pain Management,llc | Pain Medicine | 3460 Old Washington Rd, Suite 300, Waldorf, MD 20602-3240 | 2011-03-24 |
1063626836 | Richard James Brouillette | Pain Medicine | 3460 Old Washington Rd, Suite 300, Waldorf, MD 20602-3240 | 2007-05-10 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1679112650 | Center for Pain Management, LLC | Pain Medicine | 3407 Wilkens Ave Ste 240, Baltimore, MD 21229-5222 | 2019-12-23 |
1578078804 | Center for Pain Management, LLC | Pain Medicine | 5801 Allentown Road, 503, Suitland, MD 20746 | 2017-12-08 |
1508384116 | Zainab Bundu | Pain Medicine | 135 Bowie Rd, Laurel, MD 20707-4631 | 2017-09-04 |
1164781472 | Center for Pain Management,llc | Pain Medicine | 8824 Cunningham Dr Ste B, Berwyn Heights, MD 20740-2338 | 2012-05-07 |
1245596139 | Harrison Linder | Pain Medicine | 345 Saint Paul St Fl 4, Baltimore, MD 21202-2123 | 2012-04-05 |
1568601656 | Washington Metro Pain Institute | Pain Medicine | 7300 Hanover Drive # 204, Greenbelt, MD 20770 | 2009-02-12 |
1285896696 | Kenneth J. Murray, P.a. | Pain Medicine | 1310 Ruxton Rd, Towson, MD 21204-6601 | 2008-06-26 |
1619170685 | Janak A Vidyarthi | Pain Medicine | 1130 Annapolis Rd, Suite 100, Odenton, MD 21113-1648 | 2007-06-07 |
1336230416 | Carey-walter Franklin Closson | Pain Medicine | 16900 Science Dr, Ste100, Bowie, MD 20715-4401 | 2006-09-27 |
1396755286 | Christopher James Galuardi | Pain Medicine | 10308 Old Ocean City Blvd, Berlin, MD 21811-1132 | 2006-08-09 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.