Provider Demographics
NPI:1952315756
Name:ADV CNTRS FOR ORTHO SURG & SPORTS MED
Entity Type:Organization
Organization Name:ADV CNTRS FOR ORTHO SURG & SPORTS MED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OPERATIONS LIAISON
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:SEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-484-8088
Mailing Address - Street 1:10 CROSSROADS DRIVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117
Mailing Address - Country:US
Mailing Address - Phone:410-484-8088
Mailing Address - Fax:410-581-9134
Practice Address - Street 1:10 CROSSROADS DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117
Practice Address - Country:US
Practice Address - Phone:410-484-8088
Practice Address - Fax:410-581-9134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD117856OtherKAISER
MDKK05ADOtherBLUE SHILED
DCW520OtherBLUE SHILED
MDKK05ADOtherBLUE SHILED
MDCN0513Medicare PIN
MD117856OtherKAISER
MD0486020001Medicare NSC