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
5810 HUBBARD DR, ROCKVILLE, MD 20852-4818
(301) 770-6246
(703) 207-9395
Mailing address
8830 PROFESSIONAL HILL DR, FAIRFAX, VA 22031
(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
01
—
09030
AMERIGROUP
MD
01
—
326970
ANTHEM BCBS
VA
05
—
7855486000
—
MD
Enumeration date
07/18/2007
Last updated
02/13/2020
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