MEDICARE: FAMILYORTHOPAEDICS AND SPORTS MEDICINE OF NORTHERN VIRGINIA P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	0101029792	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003969049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILYORTHOPAEDICS AND SPORTS MEDICINE OF NORTHERN VIRGINIA P.C.

Provider Business Mailing Address
First Line	:	2010 OPITZ BLVD STE C
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-3359
Country	:	US
Telephone Number	:	703-690-4992
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 OPITZ BLVD STE C
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-3359
Country	:	US
Telephone Number	:	703-690-4992
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SHARON H. LOWERY
Credential	:
Telephone Number	:	703-801-1070

Provider Enumeration Date	:	01/21/2007
Last Update Date	:	10/12/2010

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