Provider Demographics
NPI:1700033990
Name:DELMARVA PAIN ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DELMARVA PAIN ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CONWORTH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAYTON-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-742-7246
Mailing Address - Street 1:201 PINE BLUFF RD
Mailing Address - Street 2:SUITE 25
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7163
Mailing Address - Country:US
Mailing Address - Phone:410-742-7246
Mailing Address - Fax:
Practice Address - Street 1:201 PINE BLUFF RD
Practice Address - Street 2:SUITE 25
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7163
Practice Address - Country:US
Practice Address - Phone:410-742-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD416007000Medicaid
MD416007000Medicaid