Provider Demographics
NPI:1932506821
Name:ORTHOTIC PROSTHETIC CENTER, INC.
Entity Type:Organization
Organization Name:ORTHOTIC PROSTHETIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORCORAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:301-906-0603
Mailing Address - Street 1:8330 PROFESSIONAL HILL DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4611
Mailing Address - Country:US
Mailing Address - Phone:703-698-5007
Mailing Address - Fax:703-207-9395
Practice Address - Street 1:224 CORNWALL ST NW
Practice Address - Street 2:CORNWALL PAVILION BUILDING 224-D SUITE 200B
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-2701
Practice Address - Country:US
Practice Address - Phone:571-291-3121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier