Healthcare Provider Details

I. General information

NPI: 1184383101
Provider Name (Legal Business Name): WASHINGTON ORTHOPAEDICS AND SPORTS MEDICINE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 LOUGHBORO RD NW STE 200
WASHINGTON DC
20016-2625
US

IV. Provider business mailing address

5454 WISCONSIN AVE STE 1000
CHEVY CHASE MD
20815-6949
US

V. Phone/Fax

Practice location:
  • Phone: 202-787-5601
  • Fax:
Mailing address:
  • Phone: 301-657-1996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: IVETTE MCNEACE
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 240-482-4550