Provider Demographics
NPI:1558487322
Name:ALLIANCE ORTHOPEDIC LABS, INC.
Entity Type:Organization
Organization Name:ALLIANCE ORTHOPEDIC LABS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:TINDALL
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:410-224-2000
Mailing Address - Street 1:304 HARRY S TRUMAN PKWY
Mailing Address - Street 2:SUITE G
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7379
Mailing Address - Country:US
Mailing Address - Phone:410-224-2000
Mailing Address - Fax:410-224-5696
Practice Address - Street 1:9678 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3670
Practice Address - Country:US
Practice Address - Phone:301-599-0001
Practice Address - Fax:301-599-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02168273332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDMJ61ALOtherCAREFIRST MD
DC027147400Medicaid
MD714501200Medicaid
DCJ5690001OtherCAREFIRST NATIONAL CAP