Provider Demographics
NPI:1528091238
Name:PAIN MEDICINE SPECIALISTS PA
Entity type:Organization
Organization Name:PAIN MEDICINE SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PANLILIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-825-6945
Mailing Address - Street 1:8322 BELLONA AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2012
Mailing Address - Country:US
Mailing Address - Phone:410-825-6945
Mailing Address - Fax:410-825-8974
Practice Address - Street 1:8322 BELLONA AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2012
Practice Address - Country:US
Practice Address - Phone:410-825-6945
Practice Address - Fax:410-825-8974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403875400Medicaid
MD589MMedicare ID - Type Unspecified