Provider Demographics
NPI:1497887343
Name:SHERWOOD HALL ORTHOPEDICS & SPORTS MEDICINE, LTD
Entity Type:Organization
Organization Name:SHERWOOD HALL ORTHOPEDICS & SPORTS MEDICINE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGO
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVALOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-780-3305
Mailing Address - Street 1:2616 SHERWOOD HALL LN
Mailing Address - Street 2:#104
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3100
Mailing Address - Country:US
Mailing Address - Phone:703-780-3305
Mailing Address - Fax:703-780-6663
Practice Address - Street 1:2616 SHERWOOD HALL LN
Practice Address - Street 2:#104
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3100
Practice Address - Country:US
Practice Address - Phone:703-780-3305
Practice Address - Fax:703-780-6663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101025745174400000X
VA0101058134174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG00276Medicare PIN