Provider Demographics
NPI:1376563809
Name:WARDELL ORTHOPAEDICS, P.C.
Entity Type:Organization
Organization Name:WARDELL ORTHOPAEDICS, P.C.
Other - Org Name:HARBOUR REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:T
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-215-1400
Mailing Address - Street 1:5818 HARBOUR VIEW BLVD # D
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3315
Mailing Address - Country:US
Mailing Address - Phone:757-215-1400
Mailing Address - Fax:757-215-1410
Practice Address - Street 1:5818 HARBOUR VIEW BLVD # D
Practice Address - Street 2:SUITE 150
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3315
Practice Address - Country:US
Practice Address - Phone:757-215-1400
Practice Address - Fax:757-215-1410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00V950W01Medicare ID - Type UnspecifiedM RATANATAYA, PA
VA004749W83Medicare ID - Type UnspecifiedDR WARDELL
VAP00100491Medicare ID - Type UnspecifiedDR WARDELL RAILROAD
VA008686W83Medicare ID - Type UnspecifiedDR J BARONE DC
VAU63415Medicare UPIN
VAB09977Medicare UPIN
VAP00209561Medicare ID - Type UnspecifiedM RATANATAYA, PA RAILROAD