Provider Demographics
NPI:1386471985
Name:ELITE SPINE & PAIN LLC
Entity type:Organization
Organization Name:ELITE SPINE & PAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:LITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-547-6464
Mailing Address - Street 1:97 THOMAS JOHNSON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4374
Mailing Address - Country:US
Mailing Address - Phone:240-547-6464
Mailing Address - Fax:
Practice Address - Street 1:800 S FREDERICK AVE STE 204
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4152
Practice Address - Country:US
Practice Address - Phone:301-591-8261
Practice Address - Fax:240-433-5572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty