Provider Demographics
NPI:1346364072
Name:VIRGINIA INTERVENTIONAL SPINE ASSOCIATES PC
Entity Type:Organization
Organization Name:VIRGINIA INTERVENTIONAL SPINE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BHAVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SUTHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-374-3233
Mailing Address - Street 1:4710 SPOTSYLVANIA PKWY
Mailing Address - Street 2:STE 201
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407
Mailing Address - Country:US
Mailing Address - Phone:540-374-3233
Mailing Address - Fax:540-374-3234
Practice Address - Street 1:4710 SPOTSYLVANIA PKWY
Practice Address - Street 2:STE 201
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407
Practice Address - Country:US
Practice Address - Phone:540-374-3233
Practice Address - Fax:540-374-3234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C10245Medicare PIN