Healthcare Provider Details

I. General information

NPI: 1215773932
Provider Name (Legal Business Name): PRECISION ORTHOPEDICS AND SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14999 HEALTH CENTER DR STE 101
BOWIE MD
20716-1075
US

IV. Provider business mailing address

14201 PARK CENTER DR STE 410
LAUREL MD
20707-5251
US

V. Phone/Fax

Practice location:
  • Phone: 301-498-0383
  • Fax:
Mailing address:
  • Phone: 301-298-5334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DONNA LEA BOATMAN
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 13-996-8743