Provider Demographics
NPI:1275985970
Name:SPINE AND PAIN CLINIC OF NORTH AMERICA, LLC
Entity Type:Organization
Organization Name:SPINE AND PAIN CLINIC OF NORTH AMERICA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAJID
Authorized Official - Middle Name:H
Authorized Official - Last Name:GHAURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-873-9596
Mailing Address - Street 1:PO BOX 18447
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4079
Mailing Address - Country:US
Mailing Address - Phone:301-873-9596
Mailing Address - Fax:703-520-7269
Practice Address - Street 1:4001 FAIR RIDGE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2917
Practice Address - Country:US
Practice Address - Phone:301-873-9596
Practice Address - Fax:703-520-7269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207LP2900X
VA0101233975208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty