Provider Demographics
NPI:1447298351
Name:CENTER FOR JOINT SURGERY AND SPORTS MEDICINE
Entity type:Organization
Organization Name:CENTER FOR JOINT SURGERY AND SPORTS MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LAING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-665-4575
Mailing Address - Street 1:13 WESTERN MARYLAND PARKWAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5146
Mailing Address - Country:US
Mailing Address - Phone:301-665-4575
Mailing Address - Fax:301-665-4576
Practice Address - Street 1:13 WESTERN MARYLAND PARKWAY
Practice Address - Street 2:SUITE 104
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5146
Practice Address - Country:US
Practice Address - Phone:301-665-4575
Practice Address - Fax:301-665-4576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0034975207X00000X
MDD0040493207X00000X
MDD0012569207X00000X
MD17351225100000X
MD19721225100000X
MD22266225100000X
MDC0002450363A00000X
MDC0003478363A00000X
MDC0003587363A00000X
MDR118305363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD923015700Medicaid
410LMedicare ID - Type UnspecifiedOFFICE MEDICARE NUMBER
MD6277210002Medicare NSC