Provider Demographics
NPI:1356831440
Name:ADVANCED PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:ADVANCED PAIN MANAGEMENT, LLC
Other - Org Name:ORTHOPEDIC WELLNESS SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHLOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-629-3990
Mailing Address - Street 1:1050 KEY PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4551
Mailing Address - Country:US
Mailing Address - Phone:240-629-3982
Mailing Address - Fax:240-629-3956
Practice Address - Street 1:11637 TERRACE DR STE 101
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3707
Practice Address - Country:US
Practice Address - Phone:240-629-3955
Practice Address - Fax:240-629-3956
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED PAIN MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-14
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical