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NPI Code Detail

MEDICARE: ADVANTIA HEALTH SPINE-SPORTS & PAIN CENTER OF MARYLAND LLC

MEDICARE: ADVANTIA HEALTH SPINE-SPORTS & PAIN CENTER OF MARYLAND 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
1207LP2900XPain Medicine (Anesthesiology) Physician

General Provider Information

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

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Directions to “ADVANTIA HEALTH SPINE-SPORTS & PAIN CENTER OF MARYLAND LLC ” Practice Location

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