Healthcare Provider Details

I. General information

NPI: 1922800358
Provider Name (Legal Business Name): ELITE SPINE & PAIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 PICCARD DR STE 102
ROCKVILLE MD
20850-4372
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 301-208-7350
  • Fax: 301-208-7355
Mailing address:
  • Phone: 240-547-6464
  • 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: JASON DANIEL LITT
Title or Position: CEO
Credential: MD
Phone: 240-547-6464