Healthcare Provider Details

I. General information

NPI: 1730389842
Provider Name (Legal Business Name): ORTHOTIC PROSTHETIC CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5810 HUBBARD DR
ROCKVILLE MD
20852-4818
US

IV. Provider business mailing address

8830 PROFESSIONAL HILL DR
FAIRFAX VA
22031
US

V. Phone/Fax

Practice location:
  • Phone: 301-770-6246
  • Fax: 703-207-9395
Mailing address:
  • Phone: 703-698-5007
  • Fax: 703-207-9395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL CORCORAN
Title or Position: CEO
Credential: CPO
Phone: 301-906-0603