Provider Demographics
NPI:1174618342
Name:MATSUNAGA PAIN MANAGEMENT, LLC
Entity type:Organization
Organization Name:MATSUNAGA PAIN MANAGEMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MATSUNAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-997-7246
Mailing Address - Street 1:10710 CHARTER DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3128
Mailing Address - Country:US
Mailing Address - Phone:410-997-7246
Mailing Address - Fax:410-997-7226
Practice Address - Street 1:8894 STANFORD BLVD STE 104
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5161
Practice Address - Country:US
Practice Address - Phone:410-997-7246
Practice Address - Fax:410-997-7226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037907207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F01017Medicare UPIN
MD312PMedicare PIN