Provider Demographics
NPI:1629686449
Name:VIRGINIA INTERVENTIONAL PAIN AND SPINE LLC
Entity Type:Organization
Organization Name:VIRGINIA INTERVENTIONAL PAIN AND SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAEED
Authorized Official - Middle Name:
Authorized Official - Last Name:ANWAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-425-1810
Mailing Address - Street 1:10500 SWANEE MILL TRCE
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-4858
Mailing Address - Country:US
Mailing Address - Phone:607-425-1810
Mailing Address - Fax:
Practice Address - Street 1:601 OLD WAGNER RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9313
Practice Address - Country:US
Practice Address - Phone:607-425-1810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0101251701OtherANESTHESIOLOGY