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General NPI Number Information
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NPI Number | 1770868903
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Entity Type | Organization
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Legal Business Name | SPINE MEDICINE AND REHAB
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 826 WASHINGTON RD SUITE 112
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City | WESTMINSTER
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State | MD
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Zip | 21157
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Country | US
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Telephone | 443-605-0500
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Fax | 866-605-3654
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Provider Business Mailing Address
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Address Line | 826 WASHINGTON RD SUITE 210
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City | WESTMINSTER
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State | MD
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Zip | 21157-5750
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Country | US
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Telephone | 443-605-0500
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Fax | 866-605-3654
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Authorized Official
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Title or Position | OWNER
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Name | DR. IRA D KORNBLUTH
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Credential |
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Telephone | 443-605-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | MD
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