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Organization
PROACTIVE PAIN AND NEUROLOGY, LLC
Active
Organization
PROACTIVE PAIN AND NEUROLOGY, LLC
Active
Parent organization
1417460619
Other names
Proactive Primary Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
1417460619
Authorized official
DENNIS DANIEL DEY MD (OWNER)
(240) 362-7025
Entity
Organization
Contact information
Practice address
925 BISHOP WALSH RD, CUMBERLAND, MD 21502-1845
(240) 362-7025
(240) 362-7064
Mailing address
PO BOX 1602, CUMBERLAND, MD 21501-1602
(240) 362-7025
(240) 362-7064
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
NULL
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
392004600
—
MD
01
—
622188
MEDICARE
MD
01
—
DL77
CAREFIRST
MD
Enumeration date
05/01/2019
Last updated
12/11/2020
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