1366310252 NPI number — ADVANCED SPINE AND PAIN CENTERS, PLLC

Table of content: (NPI 1366310252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366310252 NPI number — ADVANCED SPINE AND PAIN CENTERS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED SPINE AND PAIN CENTERS, PLLC
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:
1366310252
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
217 E CHURCHVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEL AIR
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21014-3825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-522-2727
Provider Business Mailing Address Fax Number:
703-542-3753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1147 S HANOVER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21230-3717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-522-2727
Provider Business Practice Location Address Fax Number:
703-542-3753
Provider Enumeration Date:
10/23/2025

Additional Information

Authorized Official

Authorized Official Last Name:
IONITA
Authorized Official First Name:
AURA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMIN
Authorized Official Telephone Number:
703-522-2727

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com