Healthcare Provider Details

I. General information

NPI: 1205211257
Provider Name (Legal Business Name): SPECTRUM PAIN SOLUTIONS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7131 AMBASSADOR RD SUITE 150
BALTIMORE MD
21244-2708
US

IV. Provider business mailing address

9 N MILTON AVE
BALTIMORE MD
21224-1047
US

V. Phone/Fax

Practice location:
  • Phone: 301-860-0305
  • Fax: 301-860-0307
Mailing address:
  • Phone: 301-860-0305
  • Fax: 301-860-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SARAH A MERRITT
Title or Position: OWNER
Credential: M.D.
Phone: 301-860-0305