NPIMap

Organization Active NPI

Providence Pain Management Center, PA

  • Pain Medicine (Anesthesiology) Physician
  • Laurel, MD
National Provider Identifier
1346708492
Registry record updated Oct 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
PROVIDENCE PAIN MANAGEMENT CENTER, PA
Practice address
14201 Laurel Park Dr
Suite 223
Laurel, MD 20707
Phone
(301) 798-9300
Fax
(301) 355-2101
NPI assigned
Mar 7, 2019
Organization subpart
Yes
Parent organization
PROVIDENCE PAIN MANAGEMENT CENTER, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 22, 2019

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

Authorized official

Name
Akara Forsythe, MD
Title
Ceo
Phone
(301) 750-9500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X Primary

Addresses

Primary practice location

14201 Laurel Park Dr
Suite 223
Laurel, MD 20707

Mailing address

6911 Laurel Bowie Rd
Suite 212
Bowie, MD 20721
Phone (301) 750-9500

National Provider Directory

National Provider Directory
Tax ID family
Providence Pain Management Center PA2 organizations share this tax ID, including this one
Part of
Providence Pain Management Center PA

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1551916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571702400000",
    "number": "1346708492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6911 LAUREL BOWIE RD",
            "address_2": "SUITE 212",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "20721",
            "telephone_number": "301-750-9500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14201 LAUREL PARK DR",
            "address_2": "SUITE 223",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "20707",
            "telephone_number": "301-798-9300",
            "fax_number": "301-355-2101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE PAIN MANAGEMENT CENTER, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE PAIN MANAGEMENT CENTER, PA",
        "enumeration_date": "2019-03-07",
        "last_updated": "2019-10-22",
        "status": "A",
        "authorized_official_last_name": "FORSYTHE",
        "authorized_official_first_name": "AKARA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "301-750-9500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2019; 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.