Provider Demographics
NPI:1366765901
Name:SPINE TEAM MARYLAND LLC
Entity type:Organization
Organization Name:SPINE TEAM MARYLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SEPIDEH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGHPANAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-897-9888
Mailing Address - Street 1:8116 GOOD LUCK RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3502
Mailing Address - Country:US
Mailing Address - Phone:410-897-9888
Mailing Address - Fax:410-897-9889
Practice Address - Street 1:8116 GOOD LUCK RD
Practice Address - Street 2:SUITE 205
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3502
Practice Address - Country:US
Practice Address - Phone:410-897-9888
Practice Address - Fax:410-897-9889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty