Healthcare Provider Details

I. General information

NPI: 1164589214
Provider Name (Legal Business Name): MRS. NORMA BOLTAN ZUCKERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 07/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10921 WHITERIM DR
POTOMAC MD
20854-1787
US

IV. Provider business mailing address

10921 WHITERIM DR
POTOMAC MD
20854-1787
US

V. Phone/Fax

Practice location:
  • Phone: 703-534-1031
  • Fax: 301-983-2252
Mailing address:
  • Phone: 703-534-1031
  • Fax: 301-983-2252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0904000786
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: