Provider Demographics
NPI:1245632926
Name:ORTHOSURG PHYSICIAN ASSISTANTS OF MARYLAND LLC
Entity type:Organization
Organization Name:ORTHOSURG PHYSICIAN ASSISTANTS OF MARYLAND LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:RAFFO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-607-4356
Mailing Address - Street 1:6430 ROCKLEDGE DR
Mailing Address - Street 2:SUITE 510
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1805
Mailing Address - Country:US
Mailing Address - Phone:202-607-4356
Mailing Address - Fax:
Practice Address - Street 1:6430 ROCKLEDGE DR
Practice Address - Street 2:SUITE 510
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1805
Practice Address - Country:US
Practice Address - Phone:202-607-4356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD62605207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty