Healthcare Provider Details

I. General information

NPI: 1821055898
Provider Name (Legal Business Name): CENTER FOR ORTHOPAEDICS AND SPORTS MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 HARTLAND RD STE 401
FALLS CHURCH VA
22043-3500
US

IV. Provider business mailing address

8230 BOONE BLVD SUITE 200
TYSONS CORNER VA
22182-2621
US

V. Phone/Fax

Practice location:
  • Phone: 703-848-0800
  • Fax:
Mailing address:
  • Phone: 703-848-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number36214
License Number StateVA

VIII. Authorized Official

Name: RAMESH G CHANDRA
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 703-848-0800