Provider Demographics
NPI:1386824936
Name:ADVANCED PAIN MANAGEMENT SPECIALISTS, LLC
Entity Type:Organization
Organization Name:ADVANCED PAIN MANAGEMENT SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-571-2946
Mailing Address - Street 1:116 DEFENSE HWY
Mailing Address - Street 2:SUITE 403
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7027
Mailing Address - Country:US
Mailing Address - Phone:410-571-2946
Mailing Address - Fax:410-571-2947
Practice Address - Street 1:8100 GOOD LUCK RD
Practice Address - Street 2:SUITE 402
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3500
Practice Address - Country:US
Practice Address - Phone:240-965-3617
Practice Address - Fax:410-571-2947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG01838Medicare PIN