=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063480226
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREATER WASHINGTON ORTHOPAEDIC GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9850 KEY WEST AVE SUITE 120
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20850-3960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-762-6040
-----------------------------------------------------
Fax | 301-762-6542
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 FOREST GLEN RD SUITE 400
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20910-1459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-589-3324
-----------------------------------------------------
Fax | 301-681-7575
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DANA WINKLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-589-3324
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------