Provider Demographics
NPI:1629221817
Name:ORTHOPEDIC GROUP, INC.
Entity Type:Organization
Organization Name:ORTHOPEDIC GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-722-2400
Mailing Address - Street 1:6 BLACKSTONE VALLEY PL
Mailing Address - Street 2:STE. 530
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1179
Mailing Address - Country:US
Mailing Address - Phone:401-334-3700
Mailing Address - Fax:401-334-3414
Practice Address - Street 1:6 BLACKSTONE VALLEY PL
Practice Address - Street 2:STE. 530
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1179
Practice Address - Country:US
Practice Address - Phone:401-334-3700
Practice Address - Fax:401-334-3414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0394890006Medicare NSC