Healthcare Provider Details

I. General information

NPI: 1275933533
Provider Name (Legal Business Name): REGENERATIVE ORTHOPEDICS AND SPORTS MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2014
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 OLD MEADOW RD STE 220
MC LEAN VA
22102-4330
US

IV. Provider business mailing address

1760 OLD MEADOW RD STE 220
MC LEAN VA
22102-4330
US

V. Phone/Fax

Practice location:
  • Phone: 703-783-3529
  • Fax: 844-681-7671
Mailing address:
  • Phone: 202-681-7671
  • Fax: 844-681-7671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID M WANG
Title or Position: OWNER
Credential: MD
Phone: 443-222-0714