Provider Demographics
NPI:1366631236
Name:ORTHOPAEDIC & SPORTS SPECIALISTS INC
Entity Type:Organization
Organization Name:ORTHOPAEDIC & SPORTS SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-547-0855
Mailing Address - Street 1:200 MEDICAL PKWY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4911
Mailing Address - Country:US
Mailing Address - Phone:757-547-0855
Mailing Address - Fax:757-548-9263
Practice Address - Street 1:200 MEDICAL PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4911
Practice Address - Country:US
Practice Address - Phone:757-547-0855
Practice Address - Fax:757-548-9263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB59792Medicare UPIN