Provider Demographics
NPI:1508130246
Name:VIRGINIA SPINE SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:VIRGINIA SPINE SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MUDIT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-921-4877
Mailing Address - Street 1:9625 SURVEYOR COURT
Mailing Address - Street 2:SUITE 320
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4408
Mailing Address - Country:US
Mailing Address - Phone:571-921-4877
Mailing Address - Fax:571-208-0585
Practice Address - Street 1:9625 SURVEYOR COURT
Practice Address - Street 2:SUITE 320
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4408
Practice Address - Country:US
Practice Address - Phone:571-921-4877
Practice Address - Fax:571-208-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty