Glensan Wellness and Laser Pain Center

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

GLENSAN WELLNESS AND LASER PAIN CENTER

Practice address

216 Crain Hwy N Ste 103
Glen Burnie, MD 21061-3079

Phone

(301) 272-1558

NPI assigned

Jul 12, 2024

Organization subpart

No

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

Authorized official

Name

Mosunmola Lake

Title

Manager

Phone

(301) 263-4890

Specialties & licenses 6

Addresses

Locations

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

{
    "created_epoch": "1720742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720742400000",
    "number": "1871330233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10801 GREEN ASH LN",
            "city": "BELTSVILLE",
            "state": "MD",
            "postal_code": "207053851",
            "telephone_number": "301-263-4890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 CRAIN HWY N STE 103",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210613079",
            "telephone_number": "301-272-1558"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6215 Greenbelt Rd Ste 107",
            "address_purpose": "LOCATION",
            "city": "Berwyn Heights",
            "state": "MD",
            "postal_code": "207402355",
            "country_code": "US",
            "telephone_number": "301-272-1558",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GLENSAN WELLNESS AND LASER PAIN CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-12",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A",
        "authorized_official_last_name": "LAKE",
        "authorized_official_first_name": "MOSUNMOLA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "301-263-4890"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Glen Burnie Oral Surgery Associates PC
• Glen Burnie Pharmacy
• Glen Burnie Physical Therapy & Sportscare, LLC
• Glen Burnie Physicians
• Glenard Medical Services, PA
• Gloria Kidz Dental LLC
• Gold Shield Medical Services LLC
• Marjorie Lynne Gold
• Tyler Goldberg
• Andrew Robert Goldberger, CRNP

• Clinic/Center in Glen Burnie, MD
• Providers in Glen Burnie, MD by specialty
• Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2024; 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.