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General NPI Number Information
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NPI Number | 1962696542
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Entity Type | Organization
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Legal Business Name | SPINE, SPORTS MEDICINE AND PAIN MANAGEMENT, LLC
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 08/28/2007
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Provider Practice Location Address
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Address Line | 8943 SHADY GROVE CT
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City | GAITHERSBURG
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State | MD
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Zip | 20877-1308
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Country | US
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Telephone | 301-987-8988
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Fax |
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Provider Business Mailing Address
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Address Line | 8943 SHADY GROVE CT
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City | GAITHERSBURG
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State | MD
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Zip | 20877-1308
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOAN LUO
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Credential | M.D.
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Telephone | 301-987-8988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2081P2900X
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License Number State | MD
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