MEDICARE: EASTERN CRANIAL AFFILIATES, LLC

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	335E00000X	Prosthetic/Orthotic Supplier		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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437525201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN CRANIAL AFFILIATES, LLC

Provider Business Mailing Address
First Line	:	10523 MAIN ST
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-3310
Country	:	US
Telephone Number	:	703-807-5899
Fax Number	:

Provider Business Practice Location Address
First Line	:	19450 DEERFIELD AVE STE 270
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20176-6821
Country	:	US
Telephone Number	:	703-807-5899
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOSEPH F TERPENNING
Credential	:	CO
Telephone Number	:	703-807-5899

Provider Enumeration Date	:	08/17/2015
Last Update Date	:	01/30/2026

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