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General NPI Number Information
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NPI Number | 1083617625
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Entity Type | Organization
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Legal Business Name | ORTHOPAEDIC AND SPORTS MEDICINE CENTER LLC
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 108 FORBES ST
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City | ANNAPOLIS
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State | MD
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Zip | 21401-1502
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Country | US
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Telephone | 410-268-8862
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Fax | 410-280-4701
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Provider Business Mailing Address
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Address Line | 108 FORBES ST
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City | ANNAPOLIS
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State | MD
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Zip | 21401-1502
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Country | US
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Telephone | 410-268-8862
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Fax | 410-280-4701
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Authorized Official
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Title or Position | ADMINISTRATOR CEO
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Name | MR. MARK CHAPUT
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Credential |
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Telephone | 410-268-8862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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