Healthcare Provider Details

I. General information

NPI: 1598217291
Provider Name (Legal Business Name): ADVANCED PAIN MANAGEMENT SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10905 FORT WASHINGTON RD STE 405
FT WASHINGTON MD
20744-5807
US

IV. Provider business mailing address

201 DEFENSE HWY SUITE 205
ANNAPOLIS MD
21401-8943
US

V. Phone/Fax

Practice location:
  • Phone: 410-571-2946
  • Fax:
Mailing address:
  • Phone: 410-571-2946
  • Fax: 410-571-2947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAMEAN FREAS
Title or Position: CEO/D.O.
Credential: D.O.
Phone: 410-571-2946