Provider Demographics
NPI:1215266267
Name:ADVANCED SPINE AND PAIN CENTERS, PLLC
Entity type:Organization
Organization Name:ADVANCED SPINE AND PAIN CENTERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AURA
Authorized Official - Middle Name:
Authorized Official - Last Name:IONITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-522-2727
Mailing Address - Street 1:217 E CHURCHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3825
Mailing Address - Country:US
Mailing Address - Phone:703-522-2727
Mailing Address - Fax:703-542-3753
Practice Address - Street 1:450 GARRISONVILLE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554
Practice Address - Country:US
Practice Address - Phone:703-522-2727
Practice Address - Fax:703-542-3753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243103207X00000X, 207XS0117X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10992Medicare PIN
VAPENDINGMedicare PIN