Healthcare Provider Details

I. General information

NPI: 1881661379
Provider Name (Legal Business Name): POTOMAC AMBULATORY SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8503 ARLINGTON BOULEVARD SUITE 150
FAIRFAX VA
22031-4603
US

IV. Provider business mailing address

6410 ROCKLEDGE DR SUITE 300
BETHESDA MD
20817-7811
US

V. Phone/Fax

Practice location:
  • Phone: 703-204-0000
  • Fax: 301-564-6391
Mailing address:
  • Phone: 301-564-3131
  • Fax: 301-564-6391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOH 692
License Number StateVA

VIII. Authorized Official

Name: MARK LAWRENCE WELCH
Title or Position: PARTNER / PHYSICIAN
Credential: M.D.
Phone: 301-564-3131