Organization
PROVIDENCE PAIN MANAGEMENT CENTER, P.A.
Active
Other names
Innovative Laboratories
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH MAXWELL OPPONG M.D. (CEO)
(301) 750-9500
Entity
Organization
Contact information
Practice address
6911 LAUREL BOWIE RD STE 212B, BOWIE, MD 20715-1712
(301) 755-9500
(301) 747-6017
Mailing address
6911 LAUREL BOWIE RD STE 212B, BOWIE, MD 20715-1712
(301) 755-9500
(301) 747-6017
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
21D2142104
MD
Other
Enumeration date
04/19/2018
Last updated
08/13/2019
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