Organization
ORTHOTIC PROSTHETIC CENTER, INC.
Active
Organization
ORTHOTIC PROSTHETIC CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL CORCORAN CPO (CEO)
(301) 906-0603
Entity
Organization
Contact information
Practice address
8330 PROFESSIONAL HILL DR, FAIRFAX, VA 22031-4611
(703) 698-5007
(703) 207-9395
Mailing address
8330 PROFESSIONAL HILL DR, FAIRFAX, VA 22031-4611
(703) 698-5007
(703) 207-9395
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
033067700
—
DC
05
—
09030
—
VA
01
—
229699
MAMSI ALLIANCE PROVIDER
MD
01
—
25459
KASIER PROVIER
MD
01
—
326970
ANTHEM BCBS PROVIDER
VA
05
—
9133062
—
VA
05
—
9190074
—
VA
Enumeration date
04/06/2006
Last updated
06/05/2024
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