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General NPI Number Information
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NPI Number | 1013181791
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Entity Type | Organization
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Legal Business Name | POTOMAC INOVA HEALTHCARE ALLIANCE
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 02/26/2013
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Provider Practice Location Address
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Address Line | 2296 OPITZ BLVD SUITE 140
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3300
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Country | US
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Telephone | 703-670-3349
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Fax | 703-580-0730
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Provider Business Mailing Address
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Address Line | 2990 TELESTAR CT SUITE 3PI
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City | FALLS CHURCH
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State | VA
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Zip | 22042-1207
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Country | US
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Telephone | 571-423-5727
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Fax | 571-423-5701
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. JACKIE MASON
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Credential |
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Telephone | 703-670-3349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0203X
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Taxonomy Name | Radiation Oncology Clinic/Center
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License Number |
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License Number State |
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