Healthcare Provider Details

I. General information

NPI: 1770689598
Provider Name (Legal Business Name): CENTER FOR ADVANCED ORTHOPEDIC SURGERY & PAIN MANAGEMENT PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21785 FILIGREE CT SUITE 103
ASHBURN VA
20147-6214
US

IV. Provider business mailing address

21785 FILIGREE CT SUITE 103
ASHBURN VA
20147-6214
US

V. Phone/Fax

Practice location:
  • Phone: 703-444-5447
  • Fax: 703-444-5484
Mailing address:
  • Phone: 703-444-5447
  • Fax: 703-444-5484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number010330742
License Number StateVA

VIII. Authorized Official

Name: DR. RANDOLPH BRYANT COOK
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 703-444-5447