Basic Information
| Provider Information | |||||||||
| NPI: | 1275834814 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERVENTIONAL PAIN & SPINE SPECIALISTS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12230 BRANDERS CREEK DR | ||||||||
| Address2: | |||||||||
| City: | CHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238311626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8047154709 | ||||||||
| FaxNumber: | 8047154714 | ||||||||
| Practice Location | |||||||||
| Address1: | 12230 BRANDERS CREEK DR | ||||||||
| Address2: | |||||||||
| City: | CHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8047154709 | ||||||||
| FaxNumber: | 8047154714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2010 | ||||||||
| LastUpdateDate: | 07/23/2018 | ||||||||
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| AuthorizedOfficialLastName: | KHAN | ||||||||
| AuthorizedOfficialFirstName: | NADEEM | ||||||||
| AuthorizedOfficialMiddleName: | ANWAR | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8047154709 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 0101235833 | VA | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 208VP0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.