Provider Demographics
NPI:1790871184
Name:MID-ATLANTIC NEUROSURGICAL ASSOICATES, PAIN CENTER
Entity Type:Organization
Organization Name:MID-ATLANTIC NEUROSURGICAL ASSOICATES, PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AGHA
Authorized Official - Middle Name:SHAHID
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-601-9258
Mailing Address - Street 1:2411 W BELVEDERE AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5228
Mailing Address - Country:US
Mailing Address - Phone:410-601-9258
Mailing Address - Fax:410-601-9974
Practice Address - Street 1:2411 W BELVEDERE AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5228
Practice Address - Country:US
Practice Address - Phone:410-601-9258
Practice Address - Fax:410-601-9974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical