NPIMap

Organization Active NPI

Maryland Interventional Pain Management, LLC

Doing business as Baltimore Pain Relief Center

  • General Practice Physician
  • Baltimore, MD
National Provider Identifier
1053670430
Registry record updated May 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
60828 Issued in MD
Legal business name
MARYLAND INTERVENTIONAL PAIN MANAGEMENT, LLC
Doing business as
Baltimore Pain Relief Center
Practice address
1147 S Hanover St
Baltimore, MD 21230-3717
Phone
(443) 725-4930
Fax
(443) 725-4933
NPI assigned
May 7, 2012
Last updated
May 7, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
MARYLAND INTERVENTIONAL PAIN MANAGEMENT, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 7, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Timothy J Gober, DCNPI 1679658405
Title
President
Phone
(443) 725-4930

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3825 MD
Physician Assistant 363A00000X 3868 MD
Chiropractor 111N00000X 3470 MD
General Practice Physician 208D00000X 60828 MD Primary

Addresses

Primary practice location

1147 S Hanover St
Baltimore, MD 21230-3717

Mailing address

5430 Campbell Blvd
Suite 106
White Marsh, MD 21162-5500
Phone (443) 725-4930

Other names 1

  • BALTIMORE PAIN RELIEF CENTER Doing business as

National Provider Directory

National Provider Directory
Part of
Maryland Interventional Pain Management LLC

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1336348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336348800000",
    "number": "1053670430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5430 CAMPBELL BLVD",
            "address_2": "SUITE 106",
            "city": "WHITE MARSH",
            "state": "MD",
            "postal_code": "211625500",
            "telephone_number": "443-725-4930",
            "fax_number": "443-725-4933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1147 S HANOVER ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212303717",
            "telephone_number": "443-725-4930",
            "fax_number": "443-725-4933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND INTERVENTIONAL PAIN MANAGEMENT, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARYLAND INTERVENTIONAL PAIN MANAGEMENT, LLC",
        "enumeration_date": "2012-05-07",
        "last_updated": "2012-05-07",
        "status": "A",
        "authorized_official_last_name": "GOBER",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "443-725-4930",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "3825",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "3868",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MD",
            "license": "3470",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MD",
            "license": "60828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BALTIMORE PAIN RELIEF CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.