Provider Demographics
NPI:1700880176
Name:ORTHOTIC SOLUTIONS, LLC
Entity Type:Organization
Organization Name:ORTHOTIC SOLUTIONS, LLC
Other - Org Name:ORTHOTIC SOLUTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MALAGARI
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:703-849-9200
Mailing Address - Street 1:2802 MERRILEE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4410
Mailing Address - Country:US
Mailing Address - Phone:703-849-9200
Mailing Address - Fax:703-849-8499
Practice Address - Street 1:2802 MERRILEE DR
Practice Address - Street 2:STE 100
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4410
Practice Address - Country:US
Practice Address - Phone:703-849-9200
Practice Address - Fax:703-849-8499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAS-12184335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9190571Medicaid
WV3810001834Medicaid
MD853710100Medicaid
DC033520400Medicaid
MD853710100Medicaid