Healthcare Provider Details

I. General information

NPI: 1114168556
Provider Name (Legal Business Name): ORTHOPEDIC PHYSICIANS OF ANNAPOLIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4175 N HANSON CT SUITE 302
BOWIE MD
20716-3179
US

IV. Provider business mailing address

2000 MEDICAL PKWY SUITE 101
ANNAPOLIS MD
21401-3742
US

V. Phone/Fax

Practice location:
  • Phone: 410-268-8862
  • Fax: 410-268-0380
Mailing address:
  • Phone: 410-268-8862
  • Fax: 410-268-0380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberA2505
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberA2505
License Number StateMD

VIII. Authorized Official

Name: MR. MARK R CHAPUT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 410-267-5574