Healthcare Provider Details

I. General information

NPI: 1639359508
Provider Name (Legal Business Name): MARYLAND SPINE AND BRAIN SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8178 LARK BROWN RD STE 101
ELKRIDGE MD
21075-6438
US

IV. Provider business mailing address

8178 LARK BROWN RD STE 101
ELKRIDGE MD
21075-6438
US

V. Phone/Fax

Practice location:
  • Phone: 410-646-4800
  • Fax: 410-646-9700
Mailing address:
  • Phone: 410-646-4800
  • Fax: 410-646-9700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD53752
License Number StateMD

VIII. Authorized Official

Name: BRITTANY TILMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 410-646-4800