Provider Demographics
NPI:1326046657
Name:ORTHOPAEDIC SURGEONS OF MONTGOMERY COUNTY, P.A.
Entity Type:Organization
Organization Name:ORTHOPAEDIC SURGEONS OF MONTGOMERY COUNTY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MISS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-565-3305
Mailing Address - Street 1:8830 CAMERON CT
Mailing Address - Street 2:SUITE 333
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4155
Mailing Address - Country:US
Mailing Address - Phone:301-565-3301
Mailing Address - Fax:301-587-3236
Practice Address - Street 1:8830 CAMERON CT
Practice Address - Street 2:SUITE 333
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4155
Practice Address - Country:US
Practice Address - Phone:301-565-3301
Practice Address - Fax:301-587-3236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0030963174400000X
MDD0042845174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD975041000Medicaid
MD975041000Medicaid
MDG02727Medicare PIN
MDF20150Medicare UPIN
MD0342800001Medicare NSC