Healthcare Provider Details

I. General information

NPI: 1033540133
Provider Name (Legal Business Name): FLAGSHIP PAIN MANAGEMENT AND REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2013
Last Update Date: 11/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 BALTIMORE ST SUITE 301
CUMBERLAND MD
21502-2472
US

IV. Provider business mailing address

157 BALTIMORE ST SUITE 200
CUMBERLAND MD
21502-2472
US

V. Phone/Fax

Practice location:
  • Phone: 301-722-3215
  • Fax: 301-722-1450
Mailing address:
  • Phone: 301-722-3215
  • Fax: 301-722-1450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM E FREAS JR.
Title or Position: CEO
Credential: SLP
Phone: 301-722-3215