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General NPI Number Information
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NPI Number | 1275651168
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Entity Type | Organization
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Legal Business Name | POTOMAC INTERNAL MEDICINE AND PEDIATRICS,LLC.
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 03/26/2009
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Provider Practice Location Address
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Address Line | 201 CENTENNIAL ST UNIT C-1
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City | LA PLATA
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State | MD
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Zip | 20646-5967
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Country | US
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Telephone | 301-934-9711
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Fax | 301-934-3998
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Provider Business Mailing Address
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Address Line | PO BOX 1734
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City | LA PLATA
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State | MD
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Zip | 20646-1734
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Country | US
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Telephone | 301-934-9711
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Fax | 301-934-3998
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. JAMES HARRING
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Credential | M.D.
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Telephone | 301-934-9711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D0052919
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D0052919
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License Number State | MD
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