Basic Information
| Provider Information | |||||||||
| NPI: | 1649461807 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADV CNTRS FOR ORTHO SURG & SPORTS MED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 CROSSROADS DRIVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | OWINGS MILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104848088 | ||||||||
| FaxNumber: | 4105819134 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 CROSSROADS DRIVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | OWINGS MILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104848088 | ||||||||
| FaxNumber: | 4105819134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2007 | ||||||||
| LastUpdateDate: | 05/15/2012 | ||||||||
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| AuthorizedOfficialLastName: | SEDA | ||||||||
| AuthorizedOfficialFirstName: | JULIANNE | ||||||||
| AuthorizedOfficialMiddleName: | RENE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE OPERATIONS LIAISON | ||||||||
| AuthorizedOfficialTelephone: | 4104848088 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332100000X | Y | Suppliers | Department of Veterans Affairs (VA) Pharmacy |
No ID Information.