MEDICARE: ORTHOPAEDIC ASSOCIATES OF VIRGINIA, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician

General Provider Information

NPI Number	:	1003987819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPAEDIC ASSOCIATES OF VIRGINIA, LTD

Provider Business Mailing Address
First Line	:	6275 E VIRGINIA BEACH BLVD
Second Line	:	SUITE 300
City	:	NORFOLK
State	:	VA
Zip	:	23502-2851
Country	:	US
Telephone Number	:	757-461-1688
Fax Number	:	757-455-5865

Provider Business Practice Location Address
First Line	:	2020 GENERAL BOOTH BLVD
Second Line	:	SUITE 110
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-5875
Country	:	US
Telephone Number	:	757-461-1688
Fax Number	:	757-455-5865

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	JANE SUMMERLIN
Credential	:
Telephone Number	:	757-893-1700

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	01/18/2008

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