Provider Demographics
NPI:1447278130
Name:ADVANCED ORTHOPAEDIC SPECIALISTS, PC
Entity type:Organization
Organization Name:ADVANCED ORTHOPAEDIC SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HERRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-414-9840
Mailing Address - Street 1:497 MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3189
Mailing Address - Country:US
Mailing Address - Phone:410-414-9840
Mailing Address - Fax:410-414-9841
Practice Address - Street 1:497 MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3189
Practice Address - Country:US
Practice Address - Phone:410-414-9840
Practice Address - Fax:410-414-9841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKCZ9OtherBCBS
MD772MMedicare ID - Type UnspecifiedGROUP
G49259Medicare UPIN
MD6137390001Medicare NSC