# MASSUMI REHABILITATION & PAIN MEDICINE, LLC

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

## Provider details

- **NPI number:** 1629489117
- **Authorized official:** DR. MEHRDAD MICHAEL MASSUMI M.D. (PRESIDENT/OWNER)
- **Authorized official phone:** (410) 825-5905

## Contact information

- **Practice address:** 660 KENILWORTH DR, SUITE 200, TOWSON, MD 21204-2313
- **Practice address phone:** (410) 825-5905
- **Practice address fax:** (410) 825-7712
- **Mailing address:** 660 KENILWORTH DR, SUITE 200, TOWSON, MD 21204-2313
- **Mailing address phone:** (410) 825-5905
- **Mailing address fax:** (410) 825-7712

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | D0032831 | MD | Yes |

## Other

- **Enumeration date:** 05/19/2014
- **Last updated:** 05/19/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 091911000 | — | MD |
| 01 | — | 426194 | COVENTRY | — |