Organization
MODERN PAIN & SPINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ATHANASIOS KOSTANDINOS MANOLE MD (MEDICAL DIRECTOR)
(505) 529-8511
Entity
Organization
Contact information
Practice address
1540 JUAN TABO BLVD NE STE A, ALBUQUERQUE, NM 87112-4460
(505) 529-8511
Mailing address
1540 JUAN TABO BLVD NE STE A, ALBUQUERQUE, NM 87112-4460
(595) 519-8511
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
—
—
2083X0100X
Occupational Medicine Physician
—
—
2084N0400X
Neurology Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Enumeration date
10/01/2020
Last updated
03/20/2026
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