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General NPI Number Information
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NPI Number | 1770689598
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Entity Type | Organization
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Legal Business Name | CENTER FOR ADVANCED ORTHOPEDIC SURGERY & PAIN MANAGEMENT PLC
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 05/30/2012
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Provider Practice Location Address
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Address Line | 21785 FILIGREE CT SUITE 103
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City | ASHBURN
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State | VA
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Zip | 20147-6214
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Country | US
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Telephone | 703-444-5447
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Fax | 703-444-5484
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Provider Business Mailing Address
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Address Line | 21785 FILIGREE CT SUITE 103
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City | ASHBURN
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State | VA
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Zip | 20147-6214
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Country | US
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Telephone | 703-444-5447
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Fax | 703-444-5484
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. RANDOLPH BRYANT COOK
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Credential | MD
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Telephone | 703-444-5447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain 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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 010330742
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License Number State | VA
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Taxonomy #3
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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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