Provider Demographics
NPI:1982757043
Name:ORTHOPAEDIC & SPORTS MEDICINE ASSOC PC
Entity Type:Organization
Organization Name:ORTHOPAEDIC & SPORTS MEDICINE ASSOC PC
Other - Org Name:RICHARD L GAERTNER MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:GAERTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-281-2457
Mailing Address - Street 1:133 MAPLE AVE E
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180
Mailing Address - Country:US
Mailing Address - Phone:703-281-2457
Mailing Address - Fax:703-281-1055
Practice Address - Street 1:133 MAPLE AVE E
Practice Address - Street 2:SUITE 300
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180
Practice Address - Country:US
Practice Address - Phone:703-281-2457
Practice Address - Fax:703-281-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0499530001Medicare NSC
B93500Medicare UPIN
VA409564Medicare ID - Type Unspecified