Provider Demographics
NPI:1932167863
Name:ORTHOPAEDIC ASSOCIATES OF VIRGINIA, LTD
Entity Type:Organization
Organization Name:ORTHOPAEDIC ASSOCIATES OF VIRGINIA, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-461-1688
Mailing Address - Street 1:6275 E VIRGINIA BEACH BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-2851
Mailing Address - Country:US
Mailing Address - Phone:757-461-1688
Mailing Address - Fax:757-455-5865
Practice Address - Street 1:6275 E VIRGINIA BEACH BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2851
Practice Address - Country:US
Practice Address - Phone:757-461-1688
Practice Address - Fax:757-455-5865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C00102Medicare PIN
C00101Medicare PIN