Provider Demographics
NPI:1720496649
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
Authorized Official - Prefix:
Authorized Official - First Name:DAMEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-571-2946
Mailing Address - Street 1:201 DEFENSE HWY STE 205
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7096
Mailing Address - Country:US
Mailing Address - Phone:410-571-2946
Mailing Address - Fax:410-571-2947
Practice Address - Street 1:8367 CHERRY LN
Practice Address - Street 2:UNIT 7
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4831
Practice Address - Country:US
Practice Address - Phone:410-571-2946
Practice Address - Fax:410-571-2947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207LP2900X, 208100000X, 332B00000X
MD208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6623000001OtherMEDICARE DME
MD690MMedicare PIN