Provider Demographics
NPI:1093958985
Name:SUBURBAN ORTHOPAEDIC TOTAL JOINT AND SPORTS CLINIC, P.C.
Entity Type:Organization
Organization Name:SUBURBAN ORTHOPAEDIC TOTAL JOINT AND SPORTS CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:AZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-292-7440
Mailing Address - Street 1:11701 LIVINGSTON RD
Mailing Address - Street 2:SUITE #105
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5104
Mailing Address - Country:US
Mailing Address - Phone:301-292-7440
Mailing Address - Fax:301-292-3278
Practice Address - Street 1:10905 FORT WASHINGTON RD
Practice Address - Street 2:SUITE #301
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5843
Practice Address - Country:US
Practice Address - Phone:301-292-7440
Practice Address - Fax:301-292-3278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty