Healthcare Provider Details

I. General information

NPI: 1417691247
Provider Name (Legal Business Name): REGENERATIVE ORTHOPEDICS AND SPORTS MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 WOODSIDE CT STE E
COLUMBIA MD
21046-3360
US

IV. Provider business mailing address

1760 OLD MEADOW RD STE 220
MC LEAN VA
22102-4330
US

V. Phone/Fax

Practice location:
  • Phone: 443-234-0536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN FERRELL
Title or Position: CEO
Credential:
Phone: 703-532-4892