Provider Demographics
NPI:1912070137
Name:CENTER FOR ADVANCED ORTHOPEDICS PA
Entity Type:Organization
Organization Name:CENTER FOR ADVANCED ORTHOPEDICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SHAHEER
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSAF
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:301-645-5410
Mailing Address - Street 1:PO BOX 1511
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20604-1511
Mailing Address - Country:US
Mailing Address - Phone:301-645-5410
Mailing Address - Fax:301-645-7680
Practice Address - Street 1:7 POST OFFICE ROAD
Practice Address - Street 2:SUITE Y
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2744
Practice Address - Country:US
Practice Address - Phone:301-645-5410
Practice Address - Fax:301-645-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD27167207X00000X
MDD0048029207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
202P459GMedicare ID - Type Unspecified
202PMedicare ID - Type Unspecified
MD5348670001Medicare NSC
202P460GMedicare ID - Type Unspecified
B81764Medicare UPIN
D01352Medicare UPIN