Provider Demographics
NPI:1881600419
Name:MOUNT VERNON ORTHOPAEDICS ASSOC
Entity type:Organization
Organization Name:MOUNT VERNON ORTHOPAEDICS ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-765-4321
Mailing Address - Street 1:8101 HINSON FARM RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3403
Mailing Address - Country:US
Mailing Address - Phone:703-765-4321
Mailing Address - Fax:703-780-4558
Practice Address - Street 1:8101 HINSON FARM RD
Practice Address - Street 2:SUITE 301
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3403
Practice Address - Country:US
Practice Address - Phone:703-765-4321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
VA0101035087204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
176608OtherMETRO MEDICARE GROUP PTAN
4695OtherCAREFIRST NCA GROUP PROVIDER #
145530100OtherDEPARTMENT OF LABOR
176608OtherMETRO MEDICARE GROUP PTAN
0768770001Medicare NSC
VA409102Medicare PIN