Provider Demographics
NPI:1871688945
Name:MARYLAND SPINE CARE LLC
Entity Type:Organization
Organization Name:MARYLAND SPINE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-833-3038
Mailing Address - Street 1:517 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136
Mailing Address - Country:US
Mailing Address - Phone:410-833-3038
Mailing Address - Fax:410-833-3039
Practice Address - Street 1:517 MAIN STREET
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136
Practice Address - Country:US
Practice Address - Phone:410-833-3038
Practice Address - Fax:410-833-3039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
03384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD280BMAOtherCAREFIRST MD
MDK0480001OtherBLUE CHOICE
MD62538403OtherCAREFIRST MD
MD055N901FMedicare ID - Type Unspecified
MDK0480001OtherBLUE CHOICE