Provider Demographics
NPI:1881963544
Name:PHS ORHTHOPAEDICS OLNEY
Entity type:Organization
Organization Name:PHS ORHTHOPAEDICS OLNEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-534-4255
Mailing Address - Street 1:18111 PRINCE PHILIP DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1513
Mailing Address - Country:US
Mailing Address - Phone:202-448-4014
Mailing Address - Fax:202-372-0029
Practice Address - Street 1:18111 PRINCE PHILIP DR
Practice Address - Street 2:SUITE 208
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1513
Practice Address - Country:US
Practice Address - Phone:202-448-4014
Practice Address - Fax:202-372-0029
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVIDENCE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-23
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHFD01-0212282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA09810714Medicaid
MD005145400Medicaid
DC029833400Medicaid
090006Medicare PIN