Healthcare Provider Details

I. General information

NPI: 1801186622
Provider Name (Legal Business Name): POTOMAC VALLEY PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11908 DARNESTOWN RD SUTE G & H
NORTH POTOMAC MD
20878-2295
US

IV. Provider business mailing address

11908 DARNESTOWN RD SUTE G & H
NORTH POTOMAC MD
20878-2295
US

V. Phone/Fax

Practice location:
  • Phone: 301-990-6333
  • Fax: 301-519-0474
Mailing address:
  • Phone: 301-990-6333
  • Fax: 301-519-0474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AVNEET K BAWA
Title or Position: PHYSICIAN/ OWNER
Credential: M,D.
Phone: 301-990-6333