Provider Demographics
NPI:1750810305
Name:DELMARVA PAIN & SPINE CENTER, LLC
Entity type:Organization
Organization Name:DELMARVA PAIN & SPINE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHACHI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-355-0090
Mailing Address - Street 1:1 CENTURIAN DR STE 110
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2154
Mailing Address - Country:US
Mailing Address - Phone:302-355-0900
Mailing Address - Fax:302-355-0901
Practice Address - Street 1:1 CENTURIAN DR STE 110
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2154
Practice Address - Country:US
Practice Address - Phone:302-355-0900
Practice Address - Fax:302-355-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty