Healthcare Provider Details

I. General information

NPI: 1144527003
Provider Name (Legal Business Name): CENTER FOR INTERVENTIONAL PAIN SPINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2011
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 CARTER DR STE B
MIDDLETOWN DE
19709-5845
US

IV. Provider business mailing address

291 CARTER DR STE A
MIDDLETOWN DE
19709-5845
US

V. Phone/Fax

Practice location:
  • Phone: 844-365-7246
  • Fax: 844-516-0080
Mailing address:
  • Phone: 844-365-7246
  • Fax: 844-516-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VENKATESH SUNDARARAJAN
Title or Position: OWNER
Credential:
Phone: 844-365-7246