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
9369 ATLEE ROAD UNIT 3107, MECHANICSVILLE, VA 23116
Mailing address
PO BOX 715868, PHILADELPHIA, PA 19171-5868
(180) 491-5191
(804) 560-9029
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
12/12/2019
Last updated
06/02/2022
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