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General NPI Number Information
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NPI Number | 1629221817
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC GROUP, INC.
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Dates
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Enumeration Date | 10/31/2008
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Last Update Date | 10/31/2008
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Provider Practice Location Address
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Address Line | 6 BLACKSTONE VALLEY PL STE. 530
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City | LINCOLN
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State | RI
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Zip | 02865-1179
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Country | US
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Telephone | 401-334-3700
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Fax | 401-334-3414
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Provider Business Mailing Address
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Address Line | 6 BLACKSTONE VALLEY PL STE. 530
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City | LINCOLN
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State | RI
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Zip | 02865-1179
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Country | US
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Telephone | 401-334-3700
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Fax | 401-334-3414
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | STEVEN BLAZAR
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Credential | MD
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Telephone | 401-722-2400
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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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