Provider Demographics
NPI:1881945723
Name:SPINE AND REHABILITATION PHYSICIANS, P.A.
Entity type:Organization
Organization Name:SPINE AND REHABILITATION PHYSICIANS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAURICIO
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:ACEBEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-668-7920
Mailing Address - Street 1:PO BOX 62812
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2812
Mailing Address - Country:US
Mailing Address - Phone:866-588-3588
Mailing Address - Fax:770-836-8636
Practice Address - Street 1:5500 KNOLL NORTH DR
Practice Address - Street 2:SUITE 235
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2370
Practice Address - Country:US
Practice Address - Phone:443-542-0932
Practice Address - Fax:443-542-0983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD636752081P2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD260757Medicare PIN