Healthcare Provider Details

I. General information

NPI: 1447298351
Provider Name (Legal Business Name): CENTER FOR JOINT SURGERY AND SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 WESTERN MARYLAND PARKWAY SUITE 104
HAGERSTOWN MD
21740-5146
US

IV. Provider business mailing address

13 WESTERN MARYLAND PARKWAY SUITE 104
HAGERSTOWN MD
21740-5146
US

V. Phone/Fax

Practice location:
  • Phone: 301-665-4575
  • Fax: 301-665-4576
Mailing address:
  • Phone: 301-665-4575
  • Fax: 301-665-4576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0002450
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0003478
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0003587
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR118305
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD0040493
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD0012569
License Number StateMD
# 7
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD0034975
License Number StateMD
# 8
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17351
License Number StateMD
# 9
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19721
License Number StateMD
# 10
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number22266
License Number StateMD

VIII. Authorized Official

Name: MRS. PAULETTE LYNN LAING
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 301-665-4575