Organization
PAIN MANAGEMENT ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HADDIS T HAGOS M.D. (PRSIDENT)
(301) 464-5575
Entity
Organization
Contact information
Practice address
4000 MITCHELLVILLE RD. SUITE B 116, BOWIE, MD 20716
(301) 464-5575
(301) 805-9791
Mailing address
3247 ELEANORS GARDEN WAY, WOODBINE, MD 21797-7508
(301) 704-0681
(301) 805-9791
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
D0059481
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00B889P38
PROVIDER PIN NUMBER
MD
05
—
0455830
—
DC
01
—
310473
MAMSI/ALLIANCE
—
01
—
G627/0001
BC/BS/CHOICE/FED
—
01
—
HMO 3214770
AETNA US HEALTHCARE
—
01
—
NON HMO 4240271
AETNA US HEALTHCARE
—
Enumeration date
12/10/2007
Last updated
02/08/2008
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