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
1	208VP0000X	Pain Medicine Physician

General Provider Information

NPI Number	:	1447885116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED SPINE AND PAIN, LLC

Provider Business Mailing Address
First Line	:	PO BOX 33465
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-0612
Country	:	US
Telephone Number	:	888-985-2727
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 HINGSTON AVE STE 104
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-4409
Country	:	US
Telephone Number	:	888-985-2727
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DAMEAN WILLIAM FREAS
Credential	:
Telephone Number	:	888-985-2727

Provider Enumeration Date	:	03/03/2020
Last Update Date	:	02/06/2023

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