MEDICARE: CLEARWAY PAIN SURGERY CENTER OF WINDSOR MILL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1013690536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEARWAY PAIN SURGERY CENTER OF WINDSOR MILL LLC

Provider Business Mailing Address
First Line	:	201 DEFENSE HWY STE 205
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7096
Country	:	US
Telephone Number	:	855-527-7246
Fax Number	:	866-229-5063

Provider Business Practice Location Address
First Line	:	2373 N ROLLING RD
Second Line	:
City	:	WINDSOR MILL
State	:	MD
Zip	:	21244-1952
Country	:	US
Telephone Number	:	855-527-7246
Fax Number	:	866-229-5063

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IRA KORNBLUTH
Credential	:	M.D.
Telephone Number	:	855-527-7246

Provider Enumeration Date	:	08/10/2023
Last Update Date	:	01/27/2026

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