Provider Demographics
NPI:1669014098
Name:MARYLAND PAIN AND SPINE CENTER, LLC
Entity Type:Organization
Organization Name:MARYLAND PAIN AND SPINE CENTER, LLC
Other - Org Name:MARYLAND PAIN AND SPINE CENTER, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANAI
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-751-7246
Mailing Address - Street 1:844 WASHINGTON RD STE 207
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6664
Mailing Address - Country:US
Mailing Address - Phone:410-751-7246
Mailing Address - Fax:410-751-8991
Practice Address - Street 1:844 WASHINGTON RD STE 207
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6664
Practice Address - Country:US
Practice Address - Phone:410-751-7246
Practice Address - Fax:410-751-8991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARYLAND PAIN AND SPINE CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-17
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD031LP936OtherMEDICARE PIN