Organization
OLD DOMINION ORTHOPAEDICS AND SPORTS MEDICINE, PC
Active
Other names
NORTHERN VIRGINIA ORTHOPAEDIC SPECIALIST
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EVELYN GANTT (BILLING MANAGER)
(703) 369-9070
Entity
Organization
Contact information
Practice address
8644 SUDLEY RD, STE 308, MANASSAS, VA 20110-4417
(703) 369-9070
(703) 369-9240
Mailing address
8644 SUDLEY RD, STE. 308, MANASSAS, VA 20110-4425
(703) 369-9070
(703) 369-9240
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CK5164
RAILROAD MEDICARE
—
Enumeration date
05/15/2006
Last updated
02/02/2023
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