Organization
ORTHOVIRGINIA OPERATORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE PROFFITT (CREDENTIALING/ENROLLMENT)
(804) 533-2357
Entity
Organization
Contact information
Practice address
13350 FRANKLIN FARM ROAD, STE 100, HERNDON, VA 20171-4095
(703) 810-5206
Mailing address
PO BOX 715868, PHILADELPHIA, PA 19171-5868
(804) 915-1910
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
10/31/2006
Last updated
06/03/2022
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