Provider Demographics
NPI:1518327402
Name:METROSPINE PC
Entity Type:Organization
Organization Name:METROSPINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-856-5860
Mailing Address - Street 1:9001 WOODYARD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4264
Mailing Address - Country:US
Mailing Address - Phone:301-856-5860
Mailing Address - Fax:
Practice Address - Street 1:9001 WOODYARD RD
Practice Address - Street 2:SUITE A
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4264
Practice Address - Country:US
Practice Address - Phone:301-856-5860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METROSPINE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-04
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00840Medicare UPIN
MD416234000Medicaid