Healthcare Provider Details

I. General information

NPI: 1720763444
Provider Name (Legal Business Name): INTERVENTIONAL PAIN & SPINE CARE ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 URBANA PIKE STE 207
IJAMSVILLE MD
21754-9406
US

IV. Provider business mailing address

3280 URBANA PIKE STE 207
IJAMSVILLE MD
21754-9406
US

V. Phone/Fax

Practice location:
  • Phone: 301-835-1110
  • Fax: 301-874-3416
Mailing address:
  • Phone: 301-835-1110
  • Fax: 301-874-3416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine 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 Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIET GYEBI-FOSTER
Title or Position: OWNER
Credential: MD
Phone: 301-835-1110