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NPI Code Detail

MEDICARE: ADVANCED SPINE AND PAIN, LLC

MEDICARE: ADVANCED SPINE AND PAIN, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12081P2900XPain Medicine (Physical Medicine & Rehabilitation) PhysicianNJ
22084N0400XNeurology PhysicianNJ
3208VP0014XInterventional Pain Medicine Physician
4208VP0014XInterventional Pain Medicine PhysicianNJ

General Provider Information

NPI Number : 1407002124
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED SPINE AND PAIN, LLC
Provider Business Mailing Address
First Line : 201 DEFENSE HWY STE 205
Second Line :
City : ANNAPOLIS
State : MD
Zip : 21401-7096
Country : US
Telephone Number : 888-985-2727
Fax Number : 856-779-0211
Provider Business Practice Location Address
First Line : 1400 ROUTE 70 E
Second Line :
City : CHERRY HILL
State : NJ
Zip : 08034-2240
Country : US
Telephone Number : 888-985-2727
Fax Number : 856-779-0211
Authorized Official
Title or Position : CEO
Name : DAMEAN WILLIAM FREAS
Credential :
Telephone Number : 888-985-2727
Provider Enumeration Date : 08/13/2008
Last Update Date : 02/06/2023

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