Provider Demographics
NPI:1164877684
Name:SMART PAIN SURGERY CENTER AT WHITE MARSH
Entity Type:Organization
Organization Name:SMART PAIN SURGERY CENTER AT WHITE MARSH
Other - Org Name:CLEARWAY SURGERY CENTER OF WHITE MARSH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNBLUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-693-7246
Mailing Address - Street 1:2 PARK CENTER CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4295
Mailing Address - Country:US
Mailing Address - Phone:443-693-7246
Mailing Address - Fax:
Practice Address - Street 1:8100 SANDPIPER CIR
Practice Address - Street 2:SUITE 210
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4991
Practice Address - Country:US
Practice Address - Phone:443-693-7246
Practice Address - Fax:410-870-6026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical