Provider Demographics
NPI:1275834814
Name:INTERVENTIONAL PAIN & SPINE SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:INTERVENTIONAL PAIN & SPINE SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NADEEM
Authorized Official - Middle Name:ANWAR
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-715-4709
Mailing Address - Street 1:12230 BRANDERS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1626
Mailing Address - Country:US
Mailing Address - Phone:804-715-4709
Mailing Address - Fax:804-715-4714
Practice Address - Street 1:12230 BRANDERS CREEK DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831
Practice Address - Country:US
Practice Address - Phone:804-715-4709
Practice Address - Fax:804-715-4714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-13
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235833174400000X
208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty