1306719398 NPI number — NEUROSURGICAL SPECIALTY SERVICES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306719398 NPI number — NEUROSURGICAL SPECIALTY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROSURGICAL SPECIALTY SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306719398
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 ST PAUL PLACE
Provider Second Line Business Mailing Address:
MEDICAL STAFF OFFICE
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21202-2102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-659-2963
Provider Business Mailing Address Fax Number:
410-332-9789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 SOLLERS POINT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNDALK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21222-4647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-332-9717
Provider Business Practice Location Address Fax Number:
410-659-1172
Provider Enumeration Date:
09/25/2025

Additional Information

Authorized Official

Authorized Official Last Name:
DEIBEL
Authorized Official First Name:
JUSTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT/CFO
Authorized Official Telephone Number:
410-659-2905

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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