Provider Demographics
NPI:1669037008
Name:PROACTIVE PAIN AND NEUROLOGY, LLC
Entity Type:Organization
Organization Name:PROACTIVE PAIN AND NEUROLOGY, LLC
Other - Org Name:PROACTIVE PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:DEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-362-7025
Mailing Address - Street 1:PO BOX 1602
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-1602
Mailing Address - Country:US
Mailing Address - Phone:240-362-7025
Mailing Address - Fax:240-362-7064
Practice Address - Street 1:925 BISHOP WALSH RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1845
Practice Address - Country:US
Practice Address - Phone:240-362-7025
Practice Address - Fax:240-362-7064
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1417460619
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-01
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD392004600Medicaid
MDDL77OtherCAREFIRST
MD622188OtherMEDICARE
MD999023200Medicaid