Healthcare Provider Details

I. General information

NPI: 1376289462
Provider Name (Legal Business Name): ELITE SPINE & PAIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 THOMAS JOHNSON DR STE 200
FREDERICK MD
21702-4374
US

IV. Provider business mailing address

12154 DARNESTOWN RD STE 622
GAITHERSBURG MD
20878-2206
US

V. Phone/Fax

Practice location:
  • Phone: 240-547-6464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON LITT
Title or Position: FOUNDER
Credential: MD
Phone: 240-547-6464