Provider Demographics
NPI:1053943613
Name:PAIN AND SPINE SPECIALISTS OF MARYLAND, LLC
Entity type:Organization
Organization Name:PAIN AND SPINE SPECIALISTS OF MARYLAND, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RITU
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATNAGAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:224-365-8400
Mailing Address - Street 1:2034 PRO POINTE LN
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8021
Mailing Address - Country:US
Mailing Address - Phone:301-703-8767
Mailing Address - Fax:301-703-8886
Practice Address - Street 1:420 NEFF AVE STE 230
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-5435
Practice Address - Country:US
Practice Address - Phone:301-703-8767
Practice Address - Fax:301-703-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies