# ADVANTIA HEALTH SPINE-SPORTS & PAIN CENTER OF MARYLAND LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ADVANTIA HOLDINGS OF MARYLAND LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1629447453
- **Legal business name:** ADVANTIA HOLDINGS OF MARYLAND LLC
- **Authorized official:** DR. PETER GLASS MD (CMO)
- **Authorized official phone:** (301) 453-5970

## Contact information

- **Practice address:** 12240 INDIAN CREEK CT, SUITE 130A, BELTSVILLE, MD 20705-1242
- **Practice address phone:** (571) 327-1334
- **Practice address fax:** (240) 264-8436
- **Mailing address:** 1400 FOREST GLEN RD STE 500, SILVER SPRING, MD 20910-1467
- **Mailing address phone:** (301) 453-5970

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/22/2015
- **Last updated:** 07/21/2022