Healthcare Provider Details

I. General information

NPI: 1518971373
Provider Name (Legal Business Name): CATOCTIN SPINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 TANEY AVE SUITE 100
FREDERICK MD
21702-4747
US

IV. Provider business mailing address

11206 BENT CREEK TER
GERMANTOWN MD
20876-5619
US

V. Phone/Fax

Practice location:
  • Phone: 301-668-2344
  • Fax:
Mailing address:
  • Phone: 240-453-9182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIFFIANY HOLMES
Title or Position: OFFICE MANAGER
Credential:
Phone: 240-453-9182