Healthcare Provider Details

I. General information

NPI: 1881600419
Provider Name (Legal Business Name): MOUNT VERNON ORTHOPAEDICS ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 HINSON FARM RD SUITE 301
ALEXANDRIA VA
22306-3403
US

IV. Provider business mailing address

8101 HINSON FARM RD SUITE 301
ALEXANDRIA VA
22306-3403
US

V. Phone/Fax

Practice location:
  • Phone: 703-765-4321
  • Fax:
Mailing address:
  • Phone: 703-765-4321
  • Fax: 703-780-4558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number0101035087
License Number StateVA

VIII. Authorized Official

Name: MRS. DEBRA BIRD
Title or Position: MANAGER
Credential:
Phone: 703-765-4321