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General NPI Number Information
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NPI Number | 1003969049
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Entity Type | Organization
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Legal Business Name | FAMILYORTHOPAEDICS AND SPORTS MEDICINE OF NORTHERN VIRGINIA P.C.
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Dates
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Enumeration Date | 01/21/2007
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Last Update Date | 10/12/2010
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Provider Practice Location Address
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Address Line | 2010 OPITZ BLVD STE C
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3359
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Country | US
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Telephone | 703-690-4992
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Fax |
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Provider Business Mailing Address
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Address Line | 2010 OPITZ BLVD STE C
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3359
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Country | US
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Telephone | 703-690-4992
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SHARON H. LOWERY
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Credential |
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Telephone | 703-801-1070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101029792
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License Number State | VA
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