Basic Information
Provider Information | |||||||||
NPI: | 1720240344 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | GREATER METROPOLITAN ORTHOPAEDICS | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8926 WOODYARD RD | ||||||||
Address2: | SUITE 701 | ||||||||
City: | CLINTON | ||||||||
State: | MD | ||||||||
PostalCode: | 207354220 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3018561682 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 8926 WOODYARD RD | ||||||||
Address2: | SUITE 501 | ||||||||
City: | CLINTON | ||||||||
State: | MD | ||||||||
PostalCode: | 207354220 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3017191167 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/25/2008 | ||||||||
LastUpdateDate: | 06/25/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | LEHNEN | ||||||||
AuthorizedOfficialFirstName: | SHERRY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | REIMBURSEMENT MANAGER | ||||||||
AuthorizedOfficialTelephone: | 3018561682 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 145530100 | 01 |   | DOL | OTHER | 462L | 01 |   | MARYLAND MEDICARE | OTHER | 176608 | 01 |   | METRO MEDICARE | OTHER | S176 | 01 |   | BCBS MARYLAND | OTHER | 4695 | 01 |   | BCBS NCA | OTHER | DG8302 | 01 |   | RAILROAD MEDICARE | OTHER |