Healthcare Provider Details

I. General information

NPI: 1841405859
Provider Name (Legal Business Name): INTEGRAX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 LONDONDERRY DR
EASTON MD
21601-2537
US

IV. Provider business mailing address

9 LONDONDERRY DR
EASTON MD
21601-2537
US

V. Phone/Fax

Practice location:
  • Phone: 410-822-0695
  • Fax: 410-548-9384
Mailing address:
  • Phone: 410-822-0695
  • Fax: 410-548-9384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0055412
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberD0055412
License Number StateMD

VIII. Authorized Official

Name: DR. Y R DING
Title or Position: DIRECTOR
Credential: MD
Phone: 410-822-0695