Healthcare Provider Details

I. General information

NPI: 1437737442
Provider Name (Legal Business Name): CENTER FOR SPINE SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 JEFFERSON ST
WILMINGTON DE
19801-1033
US

IV. Provider business mailing address

1219 JEFFERSON ST
WILMINGTON DE
19801-1033
US

V. Phone/Fax

Practice location:
  • Phone: 302-984-7178
  • Fax: 302-777-3444
Mailing address:
  • Phone: 302-984-7178
  • Fax: 302-777-3444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PAWAN RASTOGI
Title or Position: PRESIDENT-BOARD OF MANAGERS
Credential: MD
Phone: 302-463-5499