Mid Atlantic Pain Management, LLC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

Legal business name

MID ATLANTIC PAIN MANAGEMENT, LLC

Practice address

6355 Walker LN
Suite 510
Alexandria, VA 22310-3245

Phone

(301) 829-7683

Fax

(301) 829-7694

NPI assigned

Apr 15, 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
  • Fairfax, VA
  • NPI 1003283938
  NPD tax ID

Locations

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

{
    "created_epoch": "1429056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429056000000",
    "number": "1477949568",
    "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": "6355 WALKER LN",
            "address_2": "SUITE 510",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223103245",
            "telephone_number": "301-829-7683",
            "fax_number": "301-829-7694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID ATLANTIC PAIN MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-15",
        "last_updated": "2015-04-15",
        "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": "RAILROAD MEDICARE",
            "identifier": "DV0457",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861818270",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BC/BS",
            "identifier": "BE66",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA NON-HMO",
            "identifier": "5395974",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "0352193",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "USDOL OWCP",
            "identifier": "618183700",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sandra Jean Michell, PT
• Michelle Kondracki Oconnor PT
• Aristides John Michos, M.D.
• Pamela Mickey
• Mid Atlantic Medical Management , LLC
• Mid Atlantic Pain Management, LLC
• Mid-Atlantic Mobile Medical Imaging, LLC.
• Lamaya Middleton, LMFT
• Giselle Mignott
• Milano Medical Supplies, Inc.

• Pain Medicine (Anesthesiology) Physician in Alexandria, VA
• Providers in Alexandria, 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 Apr 15, 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.