Provider Demographics
NPI:1164877684
Name:SMART PAIN SURGERY CENTER AT WHITE MARSH
Entity type:Organization
Organization Name:SMART PAIN SURGERY CENTER AT WHITE MARSH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNBLUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-527-7246
Mailing Address - Street 1:201 DEFENSE HWY STE 205
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7096
Mailing Address - Country:US
Mailing Address - Phone:855-527-7246
Mailing Address - Fax:866-229-5063
Practice Address - Street 1:8100 SANDPIPER CIR
Practice Address - Street 2:SUITE 210
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4991
Practice Address - Country:US
Practice Address - Phone:443-693-7246
Practice Address - Fax:410-870-6026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical