Provider Demographics
NPI:1699197368
Name:NEWBRIDGE SPINE AND PAIN CENTER, LLC
Entity Type:Organization
Organization Name:NEWBRIDGE SPINE AND PAIN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MRUTHYUNJAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONCHIGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-668-9988
Mailing Address - Street 1:196 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4397
Mailing Address - Country:US
Mailing Address - Phone:301-668-9988
Mailing Address - Fax:
Practice Address - Street 1:3581 OLD WASHINGTON RD
Practice Address - Street 2:SUITE E
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3270
Practice Address - Country:US
Practice Address - Phone:301-638-5500
Practice Address - Fax:301-638-5511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic