Provider Demographics
NPI:1962709170
Name:ELITE ORTHOPAEDIC & MUSCULOSKELETAL CENTER, LLC
Entity type:Organization
Organization Name:ELITE ORTHOPAEDIC & MUSCULOSKELETAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOINFAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-691-3571
Mailing Address - Street 1:1413 MADISON PARK DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5613
Mailing Address - Country:US
Mailing Address - Phone:410-691-3571
Mailing Address - Fax:
Practice Address - Street 1:1413 MADISON PARK DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5613
Practice Address - Country:US
Practice Address - Phone:410-691-3571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6567680001Medicare NSC