Healthcare Provider Details

I. General information

NPI: 1013395409
Provider Name (Legal Business Name): ALL ABOUT PAIN AND SPINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BIDDLE AVE SUITE 203
NEWARK DE
19702-3969
US

IV. Provider business mailing address

300 E PULASKI HWY SUITE 108 & 113
ELKTON MD
21921-6737
US

V. Phone/Fax

Practice location:
  • Phone: 302-352-0517
  • Fax:
Mailing address:
  • Phone: 302-595-3670
  • Fax: 302-595-3173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberC10010198
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberC10010198
License Number StateDE

VIII. Authorized Official

Name: MOHAMED F AHMED
Title or Position: PHYSICIAN
Credential: MD
Phone: 302-352-0517