Provider Demographics
NPI:1932357530
Name:ORTHOCARERN OF FREDERICKSBURG
Entity Type:Organization
Organization Name:ORTHOCARERN OF FREDERICKSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:CROTSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-481-1919
Mailing Address - Street 1:441 CARLISLE DR STE B
Mailing Address - Street 2:#100
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4837
Mailing Address - Country:US
Mailing Address - Phone:703-481-1919
Mailing Address - Fax:703-481-1944
Practice Address - Street 1:910 CHARLES ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5810
Practice Address - Country:US
Practice Address - Phone:703-481-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOCARERN INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-07362251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health