Healthcare Provider Details

I. General information

NPI: 1710568787
Provider Name (Legal Business Name): CENTERS FOR ADVANCED ORTHOPAEDICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14348 GIDEON DR
WOODBRIDGE VA
22192-4640
US

IV. Provider business mailing address

14605 POTOMAC BRANCH DR STE 300
WOODBRIDGE VA
22191-3337
US

V. Phone/Fax

Practice location:
  • Phone: 703-490-1112
  • Fax:
Mailing address:
  • Phone:
  • 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: NICHOLAS PATRICK GROSSO
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 410-644-1880