Provider Demographics
NPI:1144300161
Name:MEDICAL CENTER ORTHOTICS AND PROSTHETICS LLC
Entity type:Organization
Organization Name:MEDICAL CENTER ORTHOTICS AND PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORCORAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:301-585-5347
Mailing Address - Street 1:2421 LINDEN LANE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1230
Mailing Address - Country:US
Mailing Address - Phone:301-585-5347
Mailing Address - Fax:301-585-4383
Practice Address - Street 1:2421 LINDEN LANE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1230
Practice Address - Country:US
Practice Address - Phone:301-585-5347
Practice Address - Fax:301-585-4383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD382002500Medicaid
MD4653970001Medicare NSC