Provider Demographics
NPI: | 1548576242 |
---|---|
Name: | GREATER METROPOLITAN ORTHOPAEDIC INSTITUTE |
Entity Type: | Organization |
Organization Name: | GREATER METROPOLITAN ORTHOPAEDIC INSTITUTE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JEFFREY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SABLOFF |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 301-856-1682 |
Mailing Address - Street 1: | 8926 WOODYARD RD |
Mailing Address - Street 2: | SUITE 701 |
Mailing Address - City: | CLINTON |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 20735-4220 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 301-856-1682 |
Mailing Address - Fax: | 301-856-8214 |
Practice Address - Street 1: | 6355 WALKER LN |
Practice Address - Street 2: | SUITE 501 |
Practice Address - City: | ALEXANDRIA |
Practice Address - State: | VA |
Practice Address - Zip Code: | 22310-3245 |
Practice Address - Country: | US |
Practice Address - Phone: | 301-856-1682 |
Practice Address - Fax: | 301-856-8214 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-08-19 |
Last Update Date: | 2012-11-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | Group - Multi-Specialty |
No | 207XS0117X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | Group - Multi-Specialty |
No | 207XX0004X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | Group - Multi-Specialty |
No | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | Group - Multi-Specialty |
No | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | Group - Multi-Specialty |
No | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | Group - Multi-Specialty |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
0254450004 | Other | MEDICARE NSC | |
145530100 | Other | DEPARTMENT OF LABOR | |
2491418 | Other | AETNA GROUP PROVIDER # VIRGINIA LOCATION | |
S176 | Other | CAREFIRST MARYLAND | |
176608 | Other | METRO MEDICARE | |
462L | Other | MARYLAND MEDICARE | |
4695 | Other | CAREFIRST BCBS NCA | |
2491418 | Other | AETNA GROUP PROVIDER # VIRGINIA LOCATION | |
S176 | Other | CAREFIRST MARYLAND |