Provider Demographics
NPI:1235308479
Name:ADVANCED CENTERS FOR ORTHOPEDIC SURGERY AND SPORTS MEDICINE
Entity type:Organization
Organization Name:ADVANCED CENTERS FOR ORTHOPEDIC SURGERY AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PALIATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-484-8088
Mailing Address - Street 1:PO BOX 759190
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-9190
Mailing Address - Country:US
Mailing Address - Phone:410-484-8088
Mailing Address - Fax:410-581-9134
Practice Address - Street 1:10 CROSSROADS DR
Practice Address - Street 2:SUITE 201
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5458
Practice Address - Country:US
Practice Address - Phone:410-484-8088
Practice Address - Fax:410-581-9134
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED CENTERS FOR ORTHOPEDIC SURGERY AND SPORTS MEDICIANE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCN0513Medicare PIN
MD066ZMedicare PIN