Healthcare Provider Details

I. General information

NPI: 1336172196
Provider Name (Legal Business Name): MEDICAL CENTER ORTHOTICS AND PROSTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 REEDSDALE RD
MILTON MA
02186
US

IV. Provider business mailing address

2421 LINDEN LN
SILVER SPRING MD
20910-1230
US

V. Phone/Fax

Practice location:
  • Phone: 617-698-6334
  • Fax: 617-698-3260
Mailing address:
  • Phone: 301-585-5347
  • Fax: 301-585-4383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: BRADFORD NEIL GARDNER
Title or Position: DIRECTOR
Credential:
Phone: 615-864-8783