Provider Demographics
NPI:1477199206
Name:MARYLAND PAIN AND SPINE CENTER, L.L.C.
Entity Type:Organization
Organization Name:MARYLAND PAIN AND SPINE CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANAI
Authorized Official - Middle Name:R
Authorized Official - Last Name:BASSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-751-8827
Mailing Address - Street 1:844 WASHINGTON RD STE 207
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6664
Mailing Address - Country:US
Mailing Address - Phone:410-751-7246
Mailing Address - Fax:410-751-8991
Practice Address - Street 1:844 WASHINGTON RD STE 207
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6664
Practice Address - Country:US
Practice Address - Phone:410-751-7246
Practice Address - Fax:410-751-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain