Healthcare Provider Details

I. General information

NPI: 1568289874
Provider Name (Legal Business Name): ADVANCED PAIN MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 CHAIRMANS CT STE 201B
FREDERICK MD
21703-2918
US

IV. Provider business mailing address

5205 CHAIRMANS CT STE 201A
FREDERICK MD
21703-2918
US

V. Phone/Fax

Practice location:
  • Phone: 240-629-3920
  • Fax:
Mailing address:
  • Phone: 240-629-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOANA GOMES
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 240-629-3982