Provider Demographics
NPI:1689642837
Name:WASHINGTON BRAIN AND SPINE INSTITUTE PC
Entity Type:Organization
Organization Name:WASHINGTON BRAIN AND SPINE INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRCHMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-718-9611
Mailing Address - Street 1:4927 AUBURN AVE
Mailing Address - Street 2:STE T-50
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814
Mailing Address - Country:US
Mailing Address - Phone:301-718-9611
Mailing Address - Fax:301-718-2979
Practice Address - Street 1:4927 AUBURN AVE
Practice Address - Street 2:STE T-50
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814
Practice Address - Country:US
Practice Address - Phone:301-718-9611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
479217Medicare ID - Type UnspecifiedGROUP