Organization
MARYLAND PAIN AND SPINE CENTER, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VAJIRA RATHNIN GUNAWARDANE M.D. (DIRECTOR)
(703) 994-6655
Entity
Organization
Contact information
Practice address
7625 MAPLE LAWN BLVD, SUITE 100, FULTON, MD 20759-2561
(703) 994-6655
(410) 730-2812
Mailing address
7625 MAPLE LAWN BLVD, SUITE 100, FULTON, MD 20759-2561
(703) 994-6655
(410) 730-2812
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
D0047120
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
272541000
—
MD
Enumeration date
10/06/2008
Last updated
01/07/2009
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