Healthcare Provider Details

I. General information

NPI: 1518983139
Provider Name (Legal Business Name): SOUTH POTOMAC BONE ASSESSMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 SOUTHERN AVE SE SUITE 210
WASHINGTON DC
20032-4689
US

IV. Provider business mailing address

1328 SOUTHERN AVE SE SUITE 210
WASHINGTON DC
20032-4689
US

V. Phone/Fax

Practice location:
  • Phone: 202-574-0540
  • Fax: 202-562-6140
Mailing address:
  • Phone: 202-574-0540
  • Fax: 202-562-6140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EDGER VERDAN POTTER
Title or Position: PRESIDENT
Credential: MD
Phone: 202-574-0540