Provider Demographics
NPI:1841405859
Name:INTEGRAX, LLC
Entity Type:Organization
Organization Name:INTEGRAX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:Y
Authorized Official - Middle Name:R
Authorized Official - Last Name:DING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-822-0695
Mailing Address - Street 1:9 LONDONDERRY DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-2537
Mailing Address - Country:US
Mailing Address - Phone:410-822-0695
Mailing Address - Fax:410-548-9384
Practice Address - Street 1:9 LONDONDERRY DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-2537
Practice Address - Country:US
Practice Address - Phone:410-822-0695
Practice Address - Fax:410-548-9384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055412207L00000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Not Answered208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD803MMedicare ID - Type Unspecified