Basic Information
| Provider Information | |||||||||
| NPI: | 1194735779 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REGIONAL ORTHOPAEDIC ASSOCIATES PA | ||||||||
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| OtherOrganizationName: | DELAWARE ORTHOPAEDIC SPECIALISTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1941 LIMESTONE RD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198085413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026559494 | ||||||||
| FaxNumber: | 3026333559 | ||||||||
| Practice Location | |||||||||
| Address1: | 1941 LIMESTONE RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198085413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026559494 | ||||||||
| FaxNumber: | 3026333350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 06/29/2021 | ||||||||
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| AuthorizedOfficialLastName: | VAUGHT | ||||||||
| AuthorizedOfficialFirstName: | JOSHUA | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3026559494 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
| NPICertificationDate: | 06/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | CA5081 | 01 | DE | MEDICARE ID TYPE UNSPECIFIED | OTHER | 0000860402 | 05 | DE | MEDICAID |