Provider Demographics
NPI:1245604719
Name:ORTHOPAEDIC CENTER AFFILIATES LLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC CENTER AFFILIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-251-1433
Mailing Address - Street 1:9420 KEY WEST AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3334
Mailing Address - Country:US
Mailing Address - Phone:301-251-1433
Mailing Address - Fax:301-424-3078
Practice Address - Street 1:9420 KEY WEST AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3334
Practice Address - Country:US
Practice Address - Phone:301-251-1433
Practice Address - Fax:301-424-3078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty