Provider Demographics
NPI:1710568787
Name:CENTERS FOR ADVANCED ORTHOPAEDICS LLC
Entity Type:Organization
Organization Name:CENTERS FOR ADVANCED ORTHOPAEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:GROSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-644-1880
Mailing Address - Street 1:14605 POTOMAC BRANCH DR STE 300
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14348 GIDEON DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4640
Practice Address - Country:US
Practice Address - Phone:703-490-1112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty