Healthcare Provider Details

I. General information

NPI: 1619301140
Provider Name (Legal Business Name): CENTERS FOR ADVANCED ORTHOPAEDICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 THOMAS JOHNSON CT
FREDERICK MD
21702-4348
US

IV. Provider business mailing address

6707 DEMOCRACY BLVD STE 504
BETHESDA MD
20817-1166
US

V. Phone/Fax

Practice location:
  • Phone: 301-694-8311
  • Fax: 301-694-3537
Mailing address:
  • Phone: 301-637-8712
  • Fax: 301-547-3366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS PATRICK GROSSO
Title or Position: AO
Credential:
Phone: 410-644-1880