Provider Demographics
NPI:1558323220
Name:ORTHOTIC PROSTHETIC CENTER, INC.
Entity type:Organization
Organization Name:ORTHOTIC PROSTHETIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORCORAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:301-906-0603
Mailing Address - Street 1:8330 PROFESSIONAL HILL DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4611
Mailing Address - Country:US
Mailing Address - Phone:703-698-5007
Mailing Address - Fax:703-207-9395
Practice Address - Street 1:8330 PROFESSIONAL HILL DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4611
Practice Address - Country:US
Practice Address - Phone:703-698-5007
Practice Address - Fax:703-207-9395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC033067700Medicaid
VA9190074Medicaid
MD229699OtherMAMSI ALLIANCE PROVIDER
VA326970OtherANTHEM BCBS PROVIDER
MD25459OtherKASIER PROVIER
VA09030Medicaid
VA9133062Medicaid
VA9133062Medicaid