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General NPI Number Information
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NPI Number | 1245582832
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Entity Type | Organization
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Legal Business Name | POTOMAC HEALTHCARE ALLIANCE LLC
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 01/27/2014
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Provider Practice Location Address
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Address Line | 198 THOMAS JOHNSON DR SUITE 5
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City | FREDERICK
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State | MD
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Zip | 21702-4398
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Country | US
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Telephone | 301-624-5390
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Fax | 301-624-5393
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Provider Business Mailing Address
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Address Line | 198 THOMAS JOHNSON DR SUITE 5
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City | FREDERICK
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State | MD
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Zip | 21702-4398
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Country | US
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Telephone | 301-624-5390
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Fax | 301-624-5393
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Authorized Official
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Title or Position | CEO
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Name | MR. PATRICK ESKEW
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Credential | CEO
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Telephone | 301-624-5390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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