Organization
MARYLAND INTERVENTIONAL PAIN MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY MARTELLONI (PRACTICE ADM)
(865) 466-0650
Entity
Organization
Contact information
Practice address
5430 CAMPBELL BLVD, SUITE 106, WHITE MARSH, MD 21162-5500
(443) 725-4930
Mailing address
5430 CAMPBELL BLVD, SUITE 106, WHITE MARSH, MD 21162-5500
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
12/12/2011
Last updated
12/12/2011
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