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General NPI Number Information
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NPI Number | 1114056256
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Entity Type | Organization
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Legal Business Name | PEAK PERFORMANCE ORTHOPEDICS, INC
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 01/20/2010
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Provider Practice Location Address
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Address Line | 625 KENT AVE SUITE 102
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City | CUMBERLAND
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State | MD
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Zip | 21502-3794
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Country | US
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Telephone | 301-777-7445
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Fax | 301-777-2501
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Provider Business Mailing Address
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Address Line | 625 KENT AVE SUITE 102
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City | CUMBERLAND
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State | MD
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Zip | 21502-3794
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Country | US
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Telephone | 301-777-7445
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Fax | 301-777-2501
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Authorized Official
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Title or Position | ORTHOPEDIC SURGEON
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Name | DR. ROY JEFFREY CARLS
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Credential | MD
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Telephone | 301-777-7445
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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 | D0056738
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License Number State | MD
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