Healthcare Provider Details

I. General information

NPI: 1497757637
Provider Name (Legal Business Name): ORTHOPAEDIC ASSOCIATES OF CENTRAL MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 BENSON AVENUE SUITE 100
BALTIMORE MD
21227
US

IV. Provider business mailing address

3421 BENSON AVENUE SUITE 100
BALTIMORE MD
21227
US

V. Phone/Fax

Practice location:
  • Phone: 410-644-1880
  • Fax: 410-644-6048
Mailing address:
  • Phone: 410-644-1880
  • Fax: 410-644-6048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN D. MADDOCK
Title or Position: CEO
Credential:
Phone: 410-644-1880