Provider Demographics
NPI:1407066822
Name:SPINAL INJECTION INSTITUTE
Entity Type:Organization
Organization Name:SPINAL INJECTION INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAHEH
Authorized Official - Middle Name:
Authorized Official - Last Name:TABAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-530-7303
Mailing Address - Street 1:6410 ROCKLEDGE DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1809
Mailing Address - Country:US
Mailing Address - Phone:301-530-7303
Mailing Address - Fax:301-530-7312
Practice Address - Street 1:6410 ROCKLEDGE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1809
Practice Address - Country:US
Practice Address - Phone:301-530-7303
Practice Address - Fax:301-530-7312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1399261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA00058Medicare ID - Type Unspecified