Organization
ADVANCED SPINE AND PAIN PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS RALEY MD (OWNER)
(703) 522-2727
Entity
Organization
Contact information
Practice address
2046 JEFFERSON DAVIS HWY, 103, STAFFORD, VA 22554-7276
(703) 522-2727
Mailing address
PO BOX 62234, BALTIMORE, MD 21264-2234
(703) 522-2727
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
0101243103
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DQ1510
RRCARE
VA
Enumeration date
07/03/2012
Last updated
08/29/2012
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