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General NPI Number Information
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NPI Number | 1629447453
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Entity Type | Organization
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Legal Business Name | ADVANTIA HEALTH SPINE-SPORTS & PAIN CENTER OF MARYLAND LLC
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 12240 INDIAN CREEK CT SUITE 130A
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City | BELTSVILLE
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State | MD
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Zip | 20705-1242
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Country | US
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Telephone | 571-327-1334
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Fax | 240-264-8436
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Provider Business Mailing Address
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Address Line | 1400 FOREST GLEN RD STE 500
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City | SILVER SPRING
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State | MD
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Zip | 20910-1467
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Country | US
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Telephone | 301-453-5970
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Fax |
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Authorized Official
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Title or Position | CMO
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Name | DR. PETER GLASS
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Credential | MD
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Telephone | 301-453-5970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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