Provider Demographics
NPI:1861818270
Name:MID ATLANTIC PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:MID ATLANTIC PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-687-0015
Mailing Address - Street 1:PO BOX 610624
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75261-0624
Mailing Address - Country:US
Mailing Address - Phone:800-394-4445
Mailing Address - Fax:706-650-1034
Practice Address - Street 1:6355 WALKER LN
Practice Address - Street 2:SUITE 200
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3245
Practice Address - Country:US
Practice Address - Phone:301-829-7683
Practice Address - Fax:301-829-7694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2019-03-07
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
0352193OtherAETNA HMO
618183700OtherUSDOL OWCP - FEDERAL BLACK LUNG
618183700OtherUSDOL OWCP - DEEOIC
DV0457OtherRAILROAD MEDICARE
BE66OtherCAREFIRST BC/BS
DV0457OtherRAILROAD MEDICARE
618183700OtherUSDOL OWCP - FEDERAL BLACK LUNG
DV0457OtherRAILROAD MEDICARE
618183700OtherUSDOL OWCP - FEDERAL BLACK LUNG