Provider Demographics
NPI:1699933747
Name:ORTHOPEDIC AND DIAGNOSTIC INSTITUTE OF VA
Entity type:Organization
Organization Name:ORTHOPEDIC AND DIAGNOSTIC INSTITUTE OF VA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-547-9301
Mailing Address - Street 1:200 MEDICAL PKWY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4911
Mailing Address - Country:US
Mailing Address - Phone:757-547-9301
Mailing Address - Fax:757-548-9263
Practice Address - Street 1:200 MEDICAL PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4911
Practice Address - Country:US
Practice Address - Phone:757-547-9301
Practice Address - Fax:757-548-9263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030584207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB07043Medicare UPIN