Healthcare Provider Details

I. General information

NPI: 1992441679
Provider Name (Legal Business Name): NICHE HAND SURGERY AND ORTHOPEDICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 EXECUTIVE PARK AVE STE 310
FAIRFAX VA
22031-2249
US

IV. Provider business mailing address

9480 MAIN ST # 1129
FAIRFAX VA
22031-4032
US

V. Phone/Fax

Practice location:
  • Phone: 703-894-0695
  • Fax: 703-783-1369
Mailing address:
  • Phone: 703-894-0695
  • Fax: 800-770-6204

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 Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: UGOCHI OKOROAFOR-RIDGWAY
Title or Position: OWNER
Credential: MD
Phone: 703-894-0695