Provider Demographics
NPI:1780628131
Name:WASHINGTON ORTHOPAEDICS AND SPORTS MEDICINE, P.A.
Entity type:Organization
Organization Name:WASHINGTON ORTHOPAEDICS AND SPORTS MEDICINE, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-657-1996
Mailing Address - Street 1:5550 FRIENDSHIP BLVD STE 360
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-7256
Mailing Address - Country:US
Mailing Address - Phone:240-483-3762
Mailing Address - Fax:301-951-6160
Practice Address - Street 1:5550 FRIENDSHIP BLVD STE 360
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-7256
Practice Address - Country:US
Practice Address - Phone:301-657-1996
Practice Address - Fax:301-951-6160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0785500001Medicare NSC
MDCG7924Medicare PIN