Provider Demographics
NPI:1063981801
Name:COMPLETE PAIN SURGERY CENTER OF WHITE MARSH LLC
Entity type:Organization
Organization Name:COMPLETE PAIN SURGERY CENTER OF WHITE MARSH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RITU
Authorized Official - Middle Name:T
Authorized Official - Last Name:BHAMBHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-777-8971
Mailing Address - Street 1:100 WALTER WARD BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1285
Mailing Address - Country:US
Mailing Address - Phone:410-777-8971
Mailing Address - Fax:877-595-7180
Practice Address - Street 1:5430 CAMPBELL BLVD STE 111
Practice Address - Street 2:
Practice Address - City:WHITE MARSH
Practice Address - State:MD
Practice Address - Zip Code:21162-5503
Practice Address - Country:US
Practice Address - Phone:410-777-8971
Practice Address - Fax:877-595-7180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-23
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical