# MARYLAND INTERVENTIONAL PAIN MANAGEMENT LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356619803
- **Authorized official:** MARY MARTELLONI (PRACTICE ADM)
- **Authorized official phone:** (865) 466-0650

## Contact information

- **Practice address:** 5430 CAMPBELL BLVD, SUITE 106, WHITE MARSH, MD 21162-5500
- **Practice address phone:** (443) 725-4930
- **Mailing address:** 5430 CAMPBELL BLVD, SUITE 106, WHITE MARSH, MD 21162-5500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/12/2011
- **Last updated:** 12/12/2011