Provider Demographics
NPI:1275933533
Name:REGENERATIVE ORTHOPEDICS AND SPORTS MEDICINE, LLC
Entity Type:Organization
Organization Name:REGENERATIVE ORTHOPEDICS AND SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-222-0714
Mailing Address - Street 1:1760 OLD MEADOW RD STE 220
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4330
Mailing Address - Country:US
Mailing Address - Phone:202-681-7671
Mailing Address - Fax:844-681-7671
Practice Address - Street 1:1760 OLD MEADOW RD STE 220
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4330
Practice Address - Country:US
Practice Address - Phone:703-783-3529
Practice Address - Fax:844-681-7671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-23
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty