Provider Demographics
NPI:1194844357
Name:METROSPINE PC
Entity Type:Organization
Organization Name:METROSPINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:HUDSON
Authorized Official - Last Name:DRAKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-856-5860
Mailing Address - Street 1:6196 OXON HILL
Mailing Address - Street 2:SUITE 510
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1400
Mailing Address - Country:US
Mailing Address - Phone:301-567-2100
Mailing Address - Fax:301-567-2399
Practice Address - Street 1:6196 OXON HILL
Practice Address - Street 2:SUITE 510
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1400
Practice Address - Country:US
Practice Address - Phone:301-567-2100
Practice Address - Fax:301-567-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18045174400000X
DC2816174400000X
TN4331174400000X
SC2569174400000X
MDD0042188174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS120-0001OtherCAREFIRST BLUECROSS BLUES
MD4162340001OtherMETROSPINE MD MEDICAID
MDDD2519OtherMEDICARE RAILROAD #
MD00B 111C40OtherMEDICARE INDIVIDUAL
MD168621600Medicaid
DC043570100OtherDR DRAKES DC MEDICAID
DC055880600OtherDC MEDICAID METRO SPINE
MDE54745Medicare UPIN
MD168621600Medicaid
MDDD2519OtherMEDICARE RAILROAD #