PROVIDENCE PAIN MANAGEMENT CENTER, PA (NPI# 1346708492) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346708492 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PAIN MANAGEMENT CENTER, PA |
| Practice Address |
14201 Laurel Park Dr Suite 223 Laurel MD 20707 |
| Mailing Address |
6911 Laurel Bowie Rd Suite 212 Bowie MD 20721 |
| Practice Telephone | 3017989300 |
| Practice Fax Number | 3013552101 |
| Mailing Telephone | 3017509500 |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2019-10-22 |
| Authorized Official Name | AKARA FORSYTHE (CEO) |
| Authorized Official Telephone | 3017509500 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE PAIN MANAGEMENT CENTER, PA |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
14201 LAUREL PARK DR SUITE 223 |
| City | LAUREL |
| State | MD |
| Zip Code | 20707 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588669360 | Bruce Maxwell Neckritz | Physical Medicine & Rehabilitation | 14201 Laurel Park Dr, Ste 223, Laurel, MD 20707-5203 | 2005-06-17 |
| 1447884234 | Janelle Marie Weather | Counselor | 14201 Laurel Park Dr, Laurel, MD 20707-5203 | 2020-03-02 |
| 1831665942 | Maeve Salanger | Audiologist | 14201 Laurel Park Dr, Laurel, MD 20707-5203 | 2018-10-16 |
| 1417333816 | Erin Lonon | Physical Therapist | 14201 Laurel Park Dr, 201m, Laurel, MD 20707-5203 | 2015-08-07 |
| 1851770481 | Open Conversations, LLC | Counselor | 14201 Laurel Park Dr, Suite 221, Laurel, MD 20707-5203 | 2015-05-28 |
| 1942618855 | Doctors of Audiology, LLC | Audiologist | 14201 Laurel Park Dr, Suite 109, Laurel, MD 20707-5203 | 2014-07-24 |
| 1891119491 | Thelma Ezibe | Nurse Practitioner | 14201 Laurel Park Dr, Suite 102a, Laurel, MD 20707-5203 | 2014-02-18 |
| 1053744904 | Stephen Williamson | Physical Therapist | 14201 Laurel Park Dr, Laurel, MD 20707-5203 | 2013-08-14 |
| 1235472606 | Mary L Carroll Services, LLC | Counselor | 14201 Laurel Park Dr, Suite 226, Laurel, MD 20707-5203 | 2013-04-03 |
| 1548505183 | Sarabjit S. Anand,md Pa | Surgery | 14201 Laurel Park Dr, 110, Laurel, MD 20707-5203 | 2012-12-08 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376157156 | Mini'imah Wilson | Social Worker | 15041 Cherrywood Dr, Laurel, MD 20707 | 2020-08-31 |
| 1548893985 | Ernest Freeman | Clinic/Center | 367 Main St., Laurel, Laurel, MD 20707 | 2020-02-13 |
| 1538701859 | Family Health and Wellness Clinic LLC | Clinic/Center | 324 Main St. #523, Laurel, MD 20707 | 2019-10-09 |
| 1467018226 | Leena Daniel | Nurse Practitioner | 13 C Street, Suite D, Laurel, MD 20707 | 2019-05-16 |
| 1538723143 | Florence Okojie | Nurse Practitioner | 13 C St Ste G, Laurel, MD 20707 | 2019-04-29 |
| 1487148631 | Munsha Sidhu Chadha | Dentist | 595 Main St Ste 237, Laurel, MD 20707 | 2018-06-20 |
| 1568953370 | Carleen Graham Schwimmer | Clinical Neuropsychologist | Veterans Affairs War Related Illness & Injury (wriisc), 50 Irving Street Nw, Washington, MD 20707 | 2018-05-29 |
| 1043709637 | Bk Behavioral Health Center | Behavior Technician | 14300 Cherry Lane Ct Ste 202-203, Laurel, MD 20707 | 2018-05-09 |
| 1053800839 | Bk Behaviorial Health Center | Substance Abuse Rehabilitation Facility | 14300 Cherry Lane Court, Suite 202-203, Laurel, MD 20707 | 2018-05-07 |
| 1316435795 | Laurel Pharmacy II LLC | Pharmacy | 14402 Baltimore Ave, Laurel, MD 20707 | 2018-05-01 |
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| Taxonomy Code | 207LP2900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Anesthesiology |
| Specialization | Pain Medicine |
| An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Anesthesiology, 2007. http://www.theaba.org/; American Osteopathic Board of Anesthesiology, 2007, http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Anesthesiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Anesthesiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720496649 | Advanced Pain Management Specialists LLC | Anesthesiology | 8367 Cherry Ln, Unit 7, Laurel, MD 20707-4831 | 2014-07-23 |
| 1962778142 | Jason Daniel Litt | Anesthesiology | 14201 Park Center Dr, Laurel, MD 20707-5217 | 2012-04-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861986572 | Accessible Integrative Medicine, LLC | Anesthesiology | 30 W Gude Dr Ste 375, Rockville, MD 20850-4300 | 2018-06-16 |
| 1760979116 | Advanced Pain Management Specialists, LLC | Anesthesiology | 331 Oak Manor Dr Ste 102, Glen Burnie, MD 21061-5553 | 2018-04-20 |
| 1407367055 | Consuelo Delores Fernandez | Anesthesiology | 6196 Oxon Hill Rd Ste 210, Oxon Hill, MD 20745-3137 | 2017-10-22 |
| 1598217291 | Advanced Pain Management Specialists, LLC | Anesthesiology | 10905 Fort Washington Rd Ste 405, Ft Washington, MD 20744-5807 | 2016-10-28 |
| 1104280957 | Brent Earls | Anesthesiology | 601 N Caroline St # 3062, Baltimore, MD 21287-0006 | 2016-04-07 |
| 1306213186 | Matsunaga Pain Management LLC | Anesthesiology | 8894 Stanford Blvd., Suite 104, Columbia, MD 21045-5161 | 2015-08-27 |
| 1801213863 | Jonathan Sean Woo | Anesthesiology | 22 South Greene Street, Room S11c00, Anestheisology, Baltimore, MD 21201 | 2014-03-27 |
| 1437409844 | Romana Baig | Anesthesiology | 1000 Bestgate Rd, Ste 400, Annapolis, MD 21401-3371 | 2012-09-12 |
| 1730455155 | Kim Vuong Hoang | Anesthesiology | 8455 Colesville Rd Ste 200, Silver Spring, MD 20910 | 2012-03-29 |
| 1295026342 | Anesthesia and Interventional Pain Management Center | Anesthesiology | 12821 Oak Hill Ave Ste 2, Hagerstown, MD 21742-2937 | 2011-04-25 |
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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.