Provider Demographics
NPI:1114056256
Name:PEAK PERFORMANCE ORTHOPEDICS, INC
Entity Type:Organization
Organization Name:PEAK PERFORMANCE ORTHOPEDICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:CARLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-777-7445
Mailing Address - Street 1:625 KENT AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3794
Mailing Address - Country:US
Mailing Address - Phone:301-777-7445
Mailing Address - Fax:301-777-2501
Practice Address - Street 1:625 KENT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3794
Practice Address - Country:US
Practice Address - Phone:301-777-7445
Practice Address - Fax:301-777-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056738174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405647700Medicaid
MD6239850002Medicare NSC
MDG14110Medicare UPIN
MD405647700Medicaid