Basic Information
| Provider Information | |||||||||
| NPI: | 1407066822 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPINAL INJECTION INSTITUTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6410 ROCKLEDGE DR | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208171809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015307303 | ||||||||
| FaxNumber: | 3015307312 | ||||||||
| Practice Location | |||||||||
| Address1: | 6410 ROCKLEDGE DR | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208171809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015307303 | ||||||||
| FaxNumber: | 3015307312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TABAR | ||||||||
| AuthorizedOfficialFirstName: | ELAHEH | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3015307303 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | A1399 | MD | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.