Provider Demographics
NPI:1265488092
Name:ORTHOTIC SOLUTIONS, LLC
Entity Type:Organization
Organization Name:ORTHOTIC SOLUTIONS, LLC
Other - Org Name:ORTHOTIC SOLUTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALAGARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-849-9200
Mailing Address - Street 1:2802 MERRILEE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4432
Mailing Address - Country:US
Mailing Address - Phone:703-849-9200
Mailing Address - Fax:
Practice Address - Street 1:188 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4505
Practice Address - Country:US
Practice Address - Phone:301-682-8712
Practice Address - Fax:301-682-8714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty