Healthcare Provider Details

I. General information

NPI: 1265488092
Provider Name (Legal Business Name): ORTHOTIC SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 THOMAS JOHNSON DR SUITE 100
FREDERICK MD
21702-4505
US

IV. Provider business mailing address

2802 MERRILEE DR SUITE 100
FAIRFAX VA
22031-4432
US

V. Phone/Fax

Practice location:
  • Phone: 301-682-8712
  • Fax: 301-682-8714
Mailing address:
  • Phone: 703-849-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN MALAGARI
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 703-849-9200