Mid Atlantic Pain Management, LLC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

Legal business name

MID ATLANTIC PAIN MANAGEMENT, LLC

Practice address

3930 Pender Dr
Suite 120
Fairfax, VA 22030-0985

Phone

(301) 829-7693

Fax

(301) 829-7694

NPI assigned

Aug 26, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lewie G Anderson

Title

Coo

Phone

(301) 829-7683

Specialties & licenses 2

Addresses

Other identifiers 6

Tax ID family

Mid Atlantic Pain Management LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mid Atlantic Pain Management, LLC

  • Pain Medicine (Anesthesiology) Physician
  • Alexandria, VA
  • NPI 1477949568
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1440547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440547200000",
    "number": "1003283938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1302 RISING RIDGE RD",
            "address_2": "SUITE 1",
            "city": "MOUNT AIRY",
            "state": "MD",
            "postal_code": "217715790",
            "telephone_number": "301-829-7683",
            "fax_number": "301-829-7694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3930 PENDER DR",
            "address_2": "SUITE 120",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220300985",
            "telephone_number": "301-829-7693",
            "fax_number": "301-829-7694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID ATLANTIC PAIN MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-26",
        "last_updated": "2015-08-26",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "LEWIE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "301-829-7683"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "0352193",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861818270",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS",
            "identifier": "BE66",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DV0457",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA NON-HMO",
            "identifier": "5395974",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "USDOL OWCP",
            "identifier": "618183700",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marissa Michalski, M.S., CCC-SLP
• Ernest Lee Michel, M.D.
• Michelle Booth, LCSW
• Nicole Michonski
• Mid Atlantic Medical Associates, LLC
• Mid-South Home Care Services, LLC
• Mariana Sylvia Joanne Middelhof, M.D
• Laura Ann Middleton, CRNP
• Jessica Migler, LCSW
• Madeleine Mihalich, LCSW

• Pain Medicine (Anesthesiology) Physician in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Pain Medicine (Anesthesiology) Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.