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General NPI Number Information
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NPI Number | 1376116343
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Entity Type | Organization
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Legal Business Name | ATLANTIC KNEE RESTORATION & REGENERATIVE MEDICINE - RESTON
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 106 ELDEN ST STE 10
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City | HERNDON
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State | VA
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Zip | 20170-4826
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Country | US
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Telephone | 703-854-1432
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Fax |
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Provider Business Mailing Address
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Address Line | 7481 RIGHT FLANK RD STE 100
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-3838
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Country | US
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Telephone | 804-877-0100
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT CRITTENDEN III
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Credential |
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Telephone | 256-302-2228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine 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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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