Healthcare Provider Details

I. General information

NPI: 1215856075
Provider Name (Legal Business Name): SPORTS & SPINE PAIN MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S TOLLGATE RD STE 302
BEL AIR MD
21014-5283
US

IV. Provider business mailing address

515 S TOLLGATE RD STE 302
BEL AIR MD
21014-5283
US

V. Phone/Fax

Practice location:
  • Phone: 410-698-1900
  • Fax: 410-773-9436
Mailing address:
  • Phone: 410-698-1900
  • Fax: 410-773-9436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY BROOKS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 410-942-0620