Provider Demographics
NPI:1336219666
Name:VALLEY ORTHOPEDICS PLLC
Entity Type:Organization
Organization Name:VALLEY ORTHOPEDICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:V
Authorized Official - Last Name:REZBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-536-8719
Mailing Address - Street 1:1870 AMHERST ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2841
Mailing Address - Country:US
Mailing Address - Phone:540-536-8719
Mailing Address - Fax:540-536-8996
Practice Address - Street 1:1870 AMHERST ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2841
Practice Address - Country:US
Practice Address - Phone:540-536-8719
Practice Address - Fax:540-536-8996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADA0553OtherRR MEDICARE
WV1804569000Medicaid
VAC08621Medicare ID - Type Unspecified