Healthcare Provider Details

I. General information

NPI: 1982318929
Provider Name (Legal Business Name): ADVANCED SPINE AND PAIN CENTERS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 GARRISONVILLE RD STE 109
STAFFORD VA
22554-1615
US

IV. Provider business mailing address

217 E CHURCHVILLE RD
BEL AIR MD
21014-3825
US

V. Phone/Fax

Practice location:
  • Phone: 703-214-6149
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AURA IONITA
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 703-522-2727