Provider Demographics
NPI:1205211257
Name:SPECTRUM PAIN SOLUTIONS PC
Entity Type:Organization
Organization Name:SPECTRUM PAIN SOLUTIONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-860-0305
Mailing Address - Street 1:9 N MILTON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-1047
Mailing Address - Country:US
Mailing Address - Phone:301-860-0305
Mailing Address - Fax:301-860-0307
Practice Address - Street 1:7131 AMBASSADOR RD
Practice Address - Street 2:SUITE 150
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2708
Practice Address - Country:US
Practice Address - Phone:301-860-0305
Practice Address - Fax:301-860-0307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD416084300Medicaid