Healthcare Provider Details

I. General information

NPI: 1588578124
Provider Name (Legal Business Name): CENTERS FOR ADVANCED ORTHOPAEDICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 MADISON PARK DR
GLEN BURNIE MD
21061-6355
US

IV. Provider business mailing address

910 FREDERICK RD
CATONSVILLE MD
21228-4516
US

V. Phone/Fax

Practice location:
  • Phone: 410-644-1880
  • Fax: 410-730-1617
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NICHOLAS GROSSO
Title or Position: AUTHORIZED SIGNER
Credential:
Phone: 410-644-1880