Provider Demographics
NPI:1376287714
Name:WAKE SPINE AND PAIN SPECIALISTS, PC
Entity Type:Organization
Organization Name:WAKE SPINE AND PAIN SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VIJAYSINHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDHARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-787-7246
Mailing Address - Street 1:3801 WAKE FOREST RD STE 210
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6864
Mailing Address - Country:US
Mailing Address - Phone:919-787-7246
Mailing Address - Fax:919-787-7247
Practice Address - Street 1:2912 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4010
Practice Address - Country:US
Practice Address - Phone:336-760-0706
Practice Address - Fax:336-760-1927
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAKE SPINE AND PAIN SPECIALISTS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty