Healthcare Provider Details

I. General information

NPI: 1841293859
Provider Name (Legal Business Name): ATLANTIC ORTHOPAEDIC GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 09/01/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S. HARBOR CITY BLVD SUITE 420
MELBOURNE FL
32901
US

IV. Provider business mailing address

2222 S. HARBOR CITY BLVD SUITE 420
MELBOURNE FL
32901
US

V. Phone/Fax

Practice location:
  • Phone: 321-768-9914
  • Fax: 321-953-1893
Mailing address:
  • Phone: 321-768-9914
  • Fax: 321-953-1893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN D. HERMANSDORFER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 321-768-9914