Provider Demographics
NPI:1821395435
Name:OLD DOMINION ORTHOPAEDIC AND SPORTS MEDICINE PC
Entity type:Organization
Organization Name:OLD DOMINION ORTHOPAEDIC AND SPORTS MEDICINE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-369-9070
Mailing Address - Street 1:8644 SUDLEY RD STE 308
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4425
Mailing Address - Country:US
Mailing Address - Phone:703-369-9070
Mailing Address - Fax:703-369-9240
Practice Address - Street 1:15195 HEATHCOAT BLVD STE 334
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-6244
Practice Address - Country:US
Practice Address - Phone:703-369-9070
Practice Address - Fax:703-369-9240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty