Provider Demographics
NPI:1144356353
Name:PMREHAB PAIN AND SPORTS MEDICINE ASSOCIATES
Entity type:Organization
Organization Name:PMREHAB PAIN AND SPORTS MEDICINE ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SEGUN
Authorized Official - Middle Name:TOYIN
Authorized Official - Last Name:DAWODU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-218-2000
Mailing Address - Street 1:PO BOX 710080
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-0080
Mailing Address - Country:US
Mailing Address - Phone:301-218-2000
Mailing Address - Fax:301-218-5016
Practice Address - Street 1:3048 MITCHELLVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1388
Practice Address - Country:US
Practice Address - Phone:301-218-2000
Practice Address - Fax:301-218-5016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-24
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD562372081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty