Healthcare Provider Details

I. General information

NPI: 1376315580
Provider Name (Legal Business Name): BETHESDA CHEVY CHASE ORTHOPAEDIC ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5716 CLEVELAND ST STE 200
VIRGINIA BEACH VA
23462-1784
US

IV. Provider business mailing address

5716 CLEVELAND ST STE 200
VIRGINIA BEACH VA
23462-1784
US

V. Phone/Fax

Practice location:
  • Phone: 757-490-4802
  • Fax:
Mailing address:
  • Phone: 757-490-4802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHUCK GRASMEDER
Title or Position: REGIONAL DIRECTOR OF OPERATIONS
Credential:
Phone: 240-482-2412