Provider Demographics
NPI:1134440092
Name:ADVANCED & INTEGRATED PAIN MANAGEMENT, LLC
Entity type:Organization
Organization Name:ADVANCED & INTEGRATED PAIN MANAGEMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUE ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PODMIJERSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:443-272-6763
Mailing Address - Street 1:P.O. BOX 298
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146
Mailing Address - Country:US
Mailing Address - Phone:443-272-6763
Mailing Address - Fax:443-272-7834
Practice Address - Street 1:8507 LIBERTY ROAD
Practice Address - Street 2:SUITE L1
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133
Practice Address - Country:US
Practice Address - Phone:443-272-6763
Practice Address - Fax:443-272-7834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01679261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty