Provider Demographics
NPI:1326418237
Name:MID-ATLANTIC PAIN SPECIALISTS, LLC
Entity Type:Organization
Organization Name:MID-ATLANTIC PAIN SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHAPDELAINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-691-2211
Mailing Address - Street 1:2466 E CHESTNUT AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-8486
Mailing Address - Country:US
Mailing Address - Phone:856-691-2211
Mailing Address - Fax:
Practice Address - Street 1:2466 E CHESTNUT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-8486
Practice Address - Country:US
Practice Address - Phone:856-691-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00585900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty