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
11240 WAPLES MILL RD, SUITE 403, FAIRFAX, VA 22030-6078
(703) 383-6424
Mailing address
PO BOX 715868, PHILADELPHIA, PA 19171-5868
(804) 915-1910
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
09/19/2014
Last updated
06/03/2022
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