Provider Demographics
NPI:1972108389
Name:PAIN AND SPINE SPECIALISTS OF MARYLAND, LLC
Entity Type:Organization
Organization Name:PAIN AND SPINE SPECIALISTS OF MARYLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-703-8767
Mailing Address - Street 1:PO BOX 16270
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4057
Mailing Address - Country:US
Mailing Address - Phone:301-703-8767
Mailing Address - Fax:301-703-8886
Practice Address - Street 1:2702 BACK ACRE CIR STE 290B
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-7769
Practice Address - Country:US
Practice Address - Phone:301-703-8767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-02
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care