Organization
PROVIDENCE PAIN MANAGEMENT CENTER, P.A.
Active
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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