Provider Demographics
NPI:1558342840
Name:ARTHRITIS & SPORTS ORTHOPAEDICS PC
Entity Type:Organization
Organization Name:ARTHRITIS & SPORTS ORTHOPAEDICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PEYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-444-5000
Mailing Address - Street 1:21475 RIDGETOP CIRCLE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166
Mailing Address - Country:US
Mailing Address - Phone:703-444-5000
Mailing Address - Fax:703-444-4999
Practice Address - Street 1:21475 RIDGETOP CIRCLE
Practice Address - Street 2:SUITE 150
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166
Practice Address - Country:US
Practice Address - Phone:703-444-5000
Practice Address - Fax:703-444-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
VA0101052246207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG00753Medicare ID - Type UnspecifiedDC MEDICARE
VA5754880001Medicare NSC
VAC05746Medicare ID - Type UnspecifiedVA MEDICARE
VAG00753-DC,C05746-VAMedicare PIN