Healthcare Provider Details

I. General information

NPI: 1376876763
Provider Name (Legal Business Name): AMERICAN SPINE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 THOMAS JOHNSON DR STE 190
FREDERICK MD
21702-4502
US

IV. Provider business mailing address

141 THOMAS JOHNSON DR STE 190
FREDERICK MD
21702-4502
US

V. Phone/Fax

Practice location:
  • Phone: 301-682-7246
  • Fax: 240-206-3205
Mailing address:
  • Phone: 301-682-7246
  • Fax: 240-206-3205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SANDEEP SHERLEKAR
Title or Position: PARTNER
Credential: M.D.
Phone: 301-461-6688