Provider Demographics
NPI:1730310632
Name:ADVANTAGE PROSTHETICS & ORTHOTICS INC
Entity Type:Organization
Organization Name:ADVANTAGE PROSTHETICS & ORTHOTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MEIR
Authorized Official - Middle Name:
Authorized Official - Last Name:RASKAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-602-7521
Mailing Address - Street 1:4000 OLD COURT RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2800
Mailing Address - Country:US
Mailing Address - Phone:443-602-7521
Mailing Address - Fax:443-403-2347
Practice Address - Street 1:4000 OLD COURT RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-2800
Practice Address - Country:US
Practice Address - Phone:443-602-7521
Practice Address - Fax:443-403-2347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD024247100Medicaid
MD024247100Medicaid