Provider Demographics
NPI:1639310824
Name:ATLANTIC PAIN INTERVENTIONS & REHABILITATION PLLC
Entity Type:Organization
Organization Name:ATLANTIC PAIN INTERVENTIONS & REHABILITATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SASTRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:TOPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-410-4219
Mailing Address - Street 1:300 MEDICAL PKWY
Mailing Address - Street 2:SUITE:306
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4985
Mailing Address - Country:US
Mailing Address - Phone:757-410-4219
Mailing Address - Fax:757-410-4237
Practice Address - Street 1:300 MEDICAL PKWY
Practice Address - Street 2:SUITE:306
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4985
Practice Address - Country:US
Practice Address - Phone:757-410-4219
Practice Address - Fax:757-410-4237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236432261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAI07342Medicare UPIN