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General NPI Number Information
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NPI Number | 1093958985
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Entity Type | Organization
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Legal Business Name | SUBURBAN ORTHOPAEDIC TOTAL JOINT AND SPORTS CLINIC, P.C.
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Dates
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Enumeration Date | 04/08/2009
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Last Update Date | 04/13/2009
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Provider Practice Location Address
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Address Line | 10905 FORT WASHINGTON RD SUITE #301
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City | FORT WASHINGTON
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State | MD
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Zip | 20744-5843
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Country | US
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Telephone | 301-292-7440
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Fax | 301-292-3278
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Provider Business Mailing Address
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Address Line | 11701 LIVINGSTON RD SUITE #105
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City | FORT WASHINGTON
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State | MD
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Zip | 20744-5104
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Country | US
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Telephone | 301-292-7440
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Fax | 301-292-3278
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMIR AZER
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Credential | MD
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Telephone | 301-292-7440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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