Organization
CENTERS FOR REHABILITATION, PAIN MGMT, & WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HEATHER A JACONSKI (BILLING REPRESENTATIVE)
(301) 953-1266
Entity
Organization
Contact information
Practice address
2600 LIBERTY HEIGHTS AVE., 3RD FLOOR, BALTIMORE, MD 21215-7804
(410) 383-4263
(410) 383-4005
Mailing address
2600 LIBERTY HEIGHTS AVE., 3RD FLOOR, BALTIMORE, MD 21215-7804
(410) 383-4263
(410) 383-4005
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
D47483
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DO4133
RAILROAD MEDICARE
—
Enumeration date
05/05/2006
Last updated
05/21/2009
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