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General NPI Number Information
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NPI Number | 1720751787
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Entity Type | Organization
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Legal Business Name | MEDICAL CENTER ORTHOTICS AND PROSTHETICS, LLC
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Dates
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Enumeration Date | 07/27/2021
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Last Update Date | 07/27/2021
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Provider Practice Location Address
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Address Line | 8330 PROFESSIONAL HILL DR
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City | FAIRFAX
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State | VA
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Zip | 22031-4681
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Country | US
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Telephone | 703-698-5007
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Fax |
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Provider Business Mailing Address
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Address Line | 2409 LINDEN LN
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City | SILVER SPRING
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State | MD
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Zip | 20910-1230
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Country | US
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Telephone | 301-585-5347
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MIKE CORCORAN
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Credential | CPO
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Telephone | 301-585-5347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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