Healthcare Provider Details

I. General information

NPI: 1043733397
Provider Name (Legal Business Name): ADVANCED PAIN MANAGEMENT SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 SALLITT DR STE 100
STEVENSVILLE MD
21666-2285
US

IV. Provider business mailing address

201 DEFENSE HWY STE 205
ANNAPOLIS MD
21401-7096
US

V. Phone/Fax

Practice location:
  • Phone: 410-224-0143
  • Fax:
Mailing address:
  • Phone: 410-571-2946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DAMEAN FREAS
Title or Position: CEO
Credential: DO
Phone: 410-571-2946