Provider Demographics
NPI:1821109679
Name:DISTRICT ORTHOPEDIC APPLIANCES, INC
Entity Type:Organization
Organization Name:DISTRICT ORTHOPEDIC APPLIANCES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROSTHETIST/ORTHOTIST CPO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUARRASI
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:703-698-7373
Mailing Address - Street 1:7702 BACKLICK RD., SUITE D
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150
Mailing Address - Country:US
Mailing Address - Phone:703-698-7373
Mailing Address - Fax:703-698-7374
Practice Address - Street 1:7702 BACKLICK RD., SUITE D
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150
Practice Address - Country:US
Practice Address - Phone:703-698-7373
Practice Address - Fax:703-698-7374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA188916OtherAMERIGROUP
VA009190520Medicaid
DC23521Medicaid
DC031668900OtherPROSTHETICS/ORTHOTICS/THERAPUETIC FOOTWEAR
MDMG64OtherBLUE CROSS BLUE SHIELD
DC4523OtherHEALTH RIGHT
VA291468OtherANTHEM BCBS
MD258901000Medicaid
DCF604OtherBLUE CROSS BLUE SHIELD
DC23521Medicaid