Provider Demographics
NPI:1598217291
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/D.O.
Authorized Official - Prefix:
Authorized Official - First Name:DAMEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:410-571-2946
Mailing Address - Street 1:201 DEFENSE HWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-8943
Mailing Address - Country:US
Mailing Address - Phone:410-571-2946
Mailing Address - Fax:410-571-2947
Practice Address - Street 1:10905 FORT WASHINGTON RD STE 405
Practice Address - Street 2:
Practice Address - City:FT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5807
Practice Address - Country:US
Practice Address - Phone:410-571-2946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC418087Medicare PIN