Provider Demographics
NPI:1902189228
Name:AVANTE ORTHOPAEDICS LLC
Entity Type:Organization
Organization Name:AVANTE ORTHOPAEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AHAM
Authorized Official - Middle Name:ELEMUWA
Authorized Official - Last Name:ONYIKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-302-1475
Mailing Address - Street 1:1600 31ST ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-3633
Mailing Address - Country:US
Mailing Address - Phone:202-302-1475
Mailing Address - Fax:
Practice Address - Street 1:7525 GREENWAY CENTER DR
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3509
Practice Address - Country:US
Practice Address - Phone:301-486-1870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0069004207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408644900Medicaid
DC037035900Medicaid
018021H13Medicare PIN
I41905Medicare UPIN