Provider Demographics
NPI:1730431321
Name:ORTHOPEDIC PHYSICIANS OF ANNAPOLIS LLC
Entity type:Organization
Organization Name:ORTHOPEDIC PHYSICIANS OF ANNAPOLIS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-267-5574
Mailing Address - Street 1:1106 ANNAPOLIS ROAD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113
Mailing Address - Country:US
Mailing Address - Phone:410-295-8900
Mailing Address - Fax:410-280-4701
Practice Address - Street 1:1106 ANNAPOLIS ROAD
Practice Address - Street 2:SUITE 130
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113
Practice Address - Country:US
Practice Address - Phone:410-295-8900
Practice Address - Fax:410-280-4701
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPEDIC PHYSICIANS OF ANNAPOLIS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-08
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD449603500Medicaid
MD449603500Medicaid