MEDICARE: PAIN AND SPINE SPECIALISTS OF MARYLAND, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	103TA0400X	Addiction (Substance Use Disorder) Psychologist
2	103TC0700X	Clinical Psychologist
3	207LP2900X	Pain Medicine (Anesthesiology) Physician
4	208VP0014X	Interventional Pain Medicine Physician
5	101YA0400X	Addiction (Substance Use Disorder) Counselor
6	208VP0000X	Pain Medicine Physician
7	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
8	101YP2500X	Professional Counselor
9	174400000X	Specialist	MD

General Provider Information

NPI Number	:	1174884258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN AND SPINE SPECIALISTS OF MARYLAND, LLC

Provider Business Mailing Address
First Line	:	2702 BACK ACRE CIR STE 290B
Second Line	:
City	:	MOUNT AIRY
State	:	MD
Zip	:	21771-7769
Country	:	US
Telephone Number	:	301-703-8767
Fax Number	:	301-703-8766

Provider Business Practice Location Address
First Line	:	2702 BACK ARCE CIRCLE
Second Line	:	290B
City	:	MOUNT AIRY
State	:	MD
Zip	:	21771-7769
Country	:	US
Telephone Number	:	301-703-8767
Fax Number	:	301-703-8766

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SUDHIR RAO
Credential	:	MD
Telephone Number	:	310-703-8767

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	11/06/2025

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Practice Location Address:

2702 BACK ACRE CIR , SUITE 290B
MOUNT AIRY, MD
21771-7769

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MOUNT AIRY, MD
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Practice Location Address:

2702 BACK ACRE CIR STE 290B
MOUNT AIRY, MD
21771-7769

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Practice Location Address:

2702 BACK ACRE CIR , SUITE 190-B
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1275919086 — AVNI INC
Practice Location Address:

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