Healthcare Provider Details

I. General information

NPI: 1720695059
Provider Name (Legal Business Name): CENTRAL VIRGINIA ORTHOPAEDICS & SPORTS MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 02/09/2021
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 GARRISONVILLE RD STE 101
STAFFORD VA
22554-1615
US

IV. Provider business mailing address

501 PARK HILL DR
FREDERICKSBURG VA
22401-3377
US

V. Phone/Fax

Practice location:
  • Phone: 540-659-4555
  • Fax: 540-659-7447
Mailing address:
  • Phone: 540-656-2786
  • Fax:

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: SHAWN RENEE SHAW
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 540-372-6737