Healthcare Provider Details

I. General information

NPI: 1427179399
Provider Name (Legal Business Name): ORTHOPAEDIC FOOT & ANKLE CENTER OF WASHINGTON, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2922 TELESTAR CT
FALLS CHURCH VA
22042-1206
US

IV. Provider business mailing address

2922 TELESTAR CT
FALLS CHURCH VA
22042-1206
US

V. Phone/Fax

Practice location:
  • Phone: 703-769-8420
  • Fax: 703-553-8647
Mailing address:
  • Phone: 703-769-8420
  • Fax: 703-553-8647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101230685
License Number StateVA

VIII. Authorized Official

Name: GABRIELLE R MORGAN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 703-769-8420