Healthcare Provider Details

I. General information

NPI: 1003254665
Provider Name (Legal Business Name): POHICK CREEK EMERGENCY PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9455 LORTON MARKET ST
LORTON VA
22079-1962
US

IV. Provider business mailing address

100 WITMER RD SUITE 220
HORSHAM PA
19044-2291
US

V. Phone/Fax

Practice location:
  • Phone: 703-523-9601
  • Fax: 703-337-4980
Mailing address:
  • Phone: 215-442-5046
  • Fax: 215-957-2875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: THOM MAYER
Title or Position: PRESIDENT/ OWNER
Credential: MD
Phone: 215-442-5046