Healthcare Provider Details

I. General information

NPI: 1881945723
Provider Name (Legal Business Name): SPINE AND REHABILITATION PHYSICIANS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 12/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 KNOLL NORTH DR SUITE 235
COLUMBIA MD
21045-2370
US

IV. Provider business mailing address

PO BOX 62812
BALTIMORE MD
21264-2812
US

V. Phone/Fax

Practice location:
  • Phone: 443-542-0932
  • Fax: 443-542-0983
Mailing address:
  • Phone: 866-588-3588
  • Fax: 770-836-8636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberD63675
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberD63675
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberD63675
License Number StateMD

VIII. Authorized Official

Name: MAURICIO JAVIER ACEBEY
Title or Position: MANAGING OWNER
Credential: M.D.
Phone: 404-668-7920