Organization
ORTHOVIRGINIA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE PROFFITT (CREDENTIALING & ENROLLMENT)
(804) 533-2357
Entity
Organization
Contact information
Practice address
4710 PUDDLEDOCK ROAD, SUITE 100, PRINCE GEORGE, VA 23875-1237
(804) 915-4604
Mailing address
PO BOX 715868, PHILADELPHIA, PA 19171-4067
(804) 915-1910
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
11/06/2013
Last updated
03/21/2022
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