Provider Demographics
NPI:1669880027
Name:MEDICAL CENTER ORTHOTICS AND PROSTHETICS, LLC
Entity type:Organization
Organization Name:MEDICAL CENTER ORTHOTICS AND PROSTHETICS, LLC
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:301-585-5347
Mailing Address - Street 1:2421 LINDEN LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1230
Mailing Address - Country:US
Mailing Address - Phone:301-585-5347
Mailing Address - Fax:301-585-4383
Practice Address - Street 1:2012 RENARD CT
Practice Address - Street 2:SUITE G
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-6761
Practice Address - Country:US
Practice Address - Phone:410-573-2374
Practice Address - Fax:410-573-2373
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL CENTER ORTHOTICS AND PROSTHETICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-30
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies