FAIRWOOD SPINE AND PAIN CENTER - NPI NUMBER 1235484353

Summary

Provider Name: FAIRWOOD SPINE AND PAIN CENTER

NPI Number: 1235484353

Clasification: Pain Medicine (208VP0014X)

Specialization: Interventional Pain Medicine

Address:
6911 LAUREL BOWIE RD
STE 212
BOWIE, MD
ZIP 20715

Phone Number: (301) 776-6500



Detailed Information

FAIRWOOD SPINE AND PAIN CENTER is an interventional pain medicine physician in Bowie, MD. The provider is interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. The assigned NPI number for this provider is 1235484353 and is registered as an organization entity type and is a multiple single specialty group.

The provider's business address is:

6911 LAUREL BOWIE RD
STE 212
BOWIE, MD
ZIP 20715-712
Phone: (301) 776-6500
Fax: (301) 965-0919

The provider's authorized official is Joseph Oppong .
The authorized official title is Co-director/president and has the following contact phone number (301) 776-6500.

The enumeration date for this NPI number is 7/15/2012 and was last updated on 12/2/2014.

Map - Location of Practice

Similar Providers

NPI Provider Name / Taxonomy
1336230416 DR. CAREY-WALTER F CLOSSON, M.D.
Pain Medicine (Interventional Pain Medicine)
1023309010 CENTER FOR PAIN MANAGEMENT, LLC
Pain Medicine (Interventional Pain Medicine)





Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 208VP0014X Pain Medicine Interventional Pain Medicine D0072898 MD No
2 208VP0014X Pain Medicine Interventional Pain Medicine D0066706 MD Yes

NPI Record

No. Field Name Field Value
1 NPI 1235484353
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name FAIRWOOD SPINE AND PAIN CENTER
5 Provider First Line Business Practice Location Address 6911 LAUREL BOWIE RD
6 Provider Second Line Business Practice Location Address STE 212
7 Provider Business Practice Location Address City Name BOWIE
8 Provider Business Practice Location Address State Name MD
9 Provider Business Practice Location Address Postal Code 207151712
10 Provider Business Practice Location Address Country Code If outside U S US
11 Provider Business Practice Location Address Telephone Number 3017766500
12 Provider Business Practice Location Address Fax Number 3019650919
13 Provider Enumeration Date 7/15/2012
14 Last Update Date 12/2/2014
15 Authorized Official Last Name OPPONG
16 Authorized Official First Name JOSEPH
17 Authorized Official Title or Position CO-DIRECTOR/PRESIDENT
18 Authorized Official Telephone Number 3017766500
19 Healthcare Provider Taxonomy Code 1 208VP0014X
20 Provider License Number 1 D0072898
21 Provider License Number State Code 1 MD
22 Healthcare Provider Primary Taxonomy Switch 1 N
23 Healthcare Provider Taxonomy Code 2 208VP0014X
24 Provider License Number 2 D0066706
25 Provider License Number State Code 2 MD
26 Healthcare Provider Primary Taxonomy Switch 2 Y
27 Is Organization Subpart N
28 Authorized Official Name Suffix Text JR.
29 Authorized Official Credential Text M.D.
30 Healthcare Provider Taxonomy Group 1 193400000X MULTIPLE SINGLE SPECIALTY GROUP
31 Healthcare Provider Taxonomy Group 2 193400000X MULTIPLE SINGLE SPECIALTY GROUP

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This page was last updated on: 12/10/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.