Healthcare Provider Details

I. General information

NPI: 1295548766
Provider Name (Legal Business Name): PAIN AND SPINE SPECIALISTS OF MARYLAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 SPECTRUM DR
FREDERICK MD
21703-7371
US

IV. Provider business mailing address

2702 BACK ACRE CIR STE 290B
MOUNT AIRY MD
21771-7769
US

V. Phone/Fax

Practice location:
  • Phone: 240-215-6047
  • Fax: 301-703-8766
Mailing address:
  • Phone: 301-760-3317
  • Fax: 301-703-8766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: SUDHIR R RAO
Title or Position: OWNER
Credential:
Phone: 301-703-8767