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General NPI Number Information
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NPI Number | 1699933747
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC AND DIAGNOSTIC INSTITUTE OF VA
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 200 MEDICAL PKWY SUITE 111
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4911
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Country | US
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Telephone | 757-547-9301
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Fax | 757-548-9263
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Provider Business Mailing Address
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Address Line | 200 MEDICAL PKWY SUITE 111
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4911
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Country | US
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Telephone | 757-547-9301
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Fax | 757-548-9263
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAWRENCE R MORALES
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Credential | M.D.
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Telephone | 757-547-9301
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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 | 0101030584
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License Number State | VA
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