Provider Demographics
NPI:1831398833
Name:POTOMAC VALLEY ORTHOPAEDIC ASSOCIATES, CHTD
Entity type:Organization
Organization Name:POTOMAC VALLEY ORTHOPAEDIC ASSOCIATES, CHTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-774-0500
Mailing Address - Street 1:10700 CHARTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3629
Mailing Address - Country:US
Mailing Address - Phone:410-992-7800
Mailing Address - Fax:410-730-2190
Practice Address - Street 1:10700 CHARTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3629
Practice Address - Country:US
Practice Address - Phone:410-992-7800
Practice Address - Fax:410-730-2190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019012174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD579LMedicare ID - Type Unspecified