Provider Demographics
NPI:1982880803
Name:MARYLAND ORTHOTICS AND PROSTHETHICS CO, INC.
Entity Type:Organization
Organization Name:MARYLAND ORTHOTICS AND PROSTHETHICS CO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-977-9853
Mailing Address - Street 1:8 NEWPORT DR STE A
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-1615
Mailing Address - Country:US
Mailing Address - Phone:410-893-1116
Mailing Address - Fax:410-665-2405
Practice Address - Street 1:15 E MAIN ST
Practice Address - Street 2:SUITE 116
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5037
Practice Address - Country:US
Practice Address - Phone:410-876-6584
Practice Address - Fax:410-665-2405
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARYLAND ORTHOTICS AND PROSTHETICS CO, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-10
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD424091000Medicaid