Healthcare Provider Details

I. General information

NPI: 1962771303
Provider Name (Legal Business Name): PHS ORTHOPAEDICS ROCKVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9707 MEDICAL CENTER DR SUITE 310
ROCKVILLE MD
20850-3348
US

IV. Provider business mailing address

1160 VARNUM ST NE ST CATHERINE'S HALL, ROOM 102
WASHINGTON DC
20017-2107
US

V. Phone/Fax

Practice location:
  • Phone: 301-315-6380
  • Fax: 301-315-6382
Mailing address:
  • Phone: 202-854-4069
  • Fax: 202-854-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberHFD01-0212
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberHFD01-0212
License Number StateDC

VIII. Authorized Official

Name: MR. CHARLES F HABERKERN
Title or Position: VP
Credential:
Phone: 202-854-4255