=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427883271
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTERS FOR ADVANCED ORTHOPAEDICS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2024
-----------------------------------------------------
Last Update Date | 09/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1015 18TH ST NW STE 300
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20036-5217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-835-2222
-----------------------------------------------------
Fax | 202-969-1798
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1015 18TH ST NW STE 300
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20036-5217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-835-2222
-----------------------------------------------------
Fax | 202-969-1798
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED SIGNER
-----------------------------------------------------
Name | NICHOLAS PATRICK GROSSO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-644-1880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------