Provider Demographics
NPI:1770813461
Name:AMERICAN ORTHOPEDIC AND REHAB
Entity type:Organization
Organization Name:AMERICAN ORTHOPEDIC AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TALAAT
Authorized Official - Middle Name:F
Authorized Official - Last Name:MAXIMOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-848-0771
Mailing Address - Street 1:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-0441
Mailing Address - Country:US
Mailing Address - Phone:434-447-8580
Mailing Address - Fax:434-447-8538
Practice Address - Street 1:306 WEAVER AVE
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1232
Practice Address - Country:US
Practice Address - Phone:434-634-0128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037825207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty