# PROACTIVE PAIN AND NEUROLOGY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** 1417460619
- **Other names:** Proactive Primary Care
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1669037008
- **Legal business name:** 1417460619
- **Authorized official:** DENNIS DANIEL DEY MD (OWNER)
- **Authorized official phone:** (240) 362-7025

## Contact information

- **Practice address:** 925 BISHOP WALSH RD, CUMBERLAND, MD 21502-1845
- **Practice address phone:** (240) 362-7025
- **Practice address fax:** (240) 362-7064
- **Mailing address:** PO BOX 1602, CUMBERLAND, MD 21501-1602
- **Mailing address phone:** (240) 362-7025
- **Mailing address fax:** (240) 362-7064

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 05/01/2019
- **Last updated:** 12/11/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 392004600 | — | MD |
| 01 | — | 622188 | MEDICARE | MD |
| 01 | — | DL77 | CAREFIRST | MD |