Organization
ATLANTIC INTERVENTIONAL PAIN MANAGEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HADDIJATOU SECKA OGUNSOLA M.D. (SOLE MANAGER)
(410) 382-3013
Entity
Organization
Contact information
Practice address
8109 RITCHIE HWY, PASADENA, MD 21122-6917
(410) 382-3013
(410) 590-8839
Mailing address
1424 ILLINOIS AVE, SEVERN, MD 21144-2643
(410) 382-3013
(410) 590-8839
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
170685
MEDICARE
MD
01
—
PENDING
CAREFIRST
DC
01
—
PENDING
RAILROAD MEDICARE
GA
01
—
PENDING
MEDICAL ASSISTANCE
MD
Enumeration date
11/24/2009
Last updated
02/05/2010
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