Provider Demographics
NPI:1902099054
Name:ORTHOPAEDIC ASSOCIATES, PA
Entity Type:Organization
Organization Name:ORTHOPAEDIC ASSOCIATES, PA
Other - Org Name:RUXTON ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:410-337-7900
Mailing Address - Street 1:PO BOX 62511
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2511
Mailing Address - Country:US
Mailing Address - Phone:410-337-5418
Mailing Address - Fax:410-337-5305
Practice Address - Street 1:8322 BELLONA AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-2065
Practice Address - Country:US
Practice Address - Phone:410-337-5418
Practice Address - Fax:410-337-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0713080001Medicare NSC