Provider Demographics
NPI:1497431803
Name:CHESAPEAKE SPINE AND PAIN LLC
Entity Type:Organization
Organization Name:CHESAPEAKE SPINE AND PAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANVER
Authorized Official - Middle Name:SALEEM
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:301-538-1226
Mailing Address - Street 1:7821 TILGHMAN ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2580
Mailing Address - Country:US
Mailing Address - Phone:301-538-1226
Mailing Address - Fax:301-893-3481
Practice Address - Street 1:110 HOSPITAL RD STE 211
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4040
Practice Address - Country:US
Practice Address - Phone:410-656-2869
Practice Address - Fax:301-893-3481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-22
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty