Provider Demographics
NPI:1144310921
Name:ADVANCED PAIN MEDICINE INSTITUTE, PC
Entity type:Organization
Organization Name:ADVANCED PAIN MEDICINE INSTITUTE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANANGEMENT, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHORBANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-220-1333
Mailing Address - Street 1:P O BOX 71155
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20813
Mailing Address - Country:US
Mailing Address - Phone:301-220-1333
Mailing Address - Fax:240-539-2533
Practice Address - Street 1:7500 GREENWAY CENTER DR STE 520
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3578
Practice Address - Country:US
Practice Address - Phone:301-220-1333
Practice Address - Fax:240-539-2533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0065935207L00000X, 207LA0401X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3169421Medicaid
MD414115600Medicaid
DC094202400Medicaid
DC094202400Medicaid
MD6157240001Medicare NSC
MDA22621Medicare PIN
G02663Medicare PIN