Organization
MID ATLANTIC PAIN MANAGEMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEWIE G ANDERSON (COO)
(301) 829-7683
Entity
Organization
Contact information
Practice address
3930 PENDER DR, SUITE 120, FAIRFAX, VA 22030-0985
(301) 829-7693
(301) 829-7694
Mailing address
1302 RISING RIDGE RD, SUITE 1, MOUNT AIRY, MD 21771-5790
(301) 829-7683
(301) 829-7694
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0352193
AETNA HMO
—
05
—
1861818270
—
VA
01
—
5395974
AETNA NON-HMO
—
01
—
618183700
USDOL OWCP
—
01
—
BE66
CAREFIRST BCBS
—
01
—
DV0457
RAILROAD MEDICARE
—
Enumeration date
08/26/2015
Last updated
08/26/2015
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