Healthcare Provider Details

I. General information

NPI: 1700880176
Provider Name (Legal Business Name): ORTHOTIC SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 MERRILEE DR STE 100
FAIRFAX VA
22031-4410
US

IV. Provider business mailing address

2802 MERRILEE DR STE 100
FAIRFAX VA
22031-4410
US

V. Phone/Fax

Practice location:
  • Phone: 703-849-9200
  • Fax: 703-849-8499
Mailing address:
  • Phone: 703-849-9200
  • Fax: 703-849-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberS-12184
License Number StateVA

VIII. Authorized Official

Name: MR. MICHAEL D MALAGARI
Title or Position: PRESIDENT
Credential: C.O.
Phone: 703-849-9200