Provider Demographics
NPI:1730389842
Name:ORTHOTIC PROSTHETIC CENTER, INC.
Entity type:Organization
Organization Name:ORTHOTIC PROSTHETIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORCORAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:301-906-0603
Mailing Address - Street 1:8830 PROFESSIONAL HILL DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031
Mailing Address - Country:US
Mailing Address - Phone:703-698-5007
Mailing Address - Fax:703-207-9395
Practice Address - Street 1:5810 HUBBARD DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4818
Practice Address - Country:US
Practice Address - Phone:301-770-6246
Practice Address - Fax:703-207-9395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD09030OtherAMERIGROUP
VA326970OtherANTHEM BCBS
DC033067700Medicaid
MD7855486000Medicaid
0202350002Medicare NSC