Provider Demographics
NPI:1063669927
Name:GARDINER RAFFO SPORTS MED ORTHO PC
Entity Type:Organization
Organization Name:GARDINER RAFFO SPORTS MED ORTHO PC
Other - Org Name:MARYLAND ORTHOPEDIC SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAFFO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-515-0900
Mailing Address - Street 1:6430 ROCKLEDGE DR
Mailing Address - Street 2:510
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1805
Mailing Address - Country:US
Mailing Address - Phone:301-515-0900
Mailing Address - Fax:301-530-1431
Practice Address - Street 1:6430 ROCKLEDGE DR
Practice Address - Street 2:510
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1805
Practice Address - Country:US
Practice Address - Phone:301-515-0900
Practice Address - Fax:301-530-1431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062605207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG03543Medicare UPIN
MDI10899Medicare UPIN
MDH24990Medicare UPIN
MD6282180001Medicare NSC