Provider Demographics
NPI:1518285733
Name:ADVANCED PAIN MANAGEMENT SPECIALISTS, LLC
Entity Type:Organization
Organization Name:ADVANCED PAIN MANAGEMENT SPECIALISTS, LLC
Other - Org Name:CLEARWAY PAIN SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-571-2946
Mailing Address - Street 1:201 DEFENSE HWY STE 205
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7096
Mailing Address - Country:US
Mailing Address - Phone:443-837-9914
Mailing Address - Fax:
Practice Address - Street 1:120 SALLITT DR
Practice Address - Street 2:SUITE D
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2154
Practice Address - Country:US
Practice Address - Phone:410-604-2203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center