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General NPI Number Information
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NPI Number | 1427452689
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Entity Type | Organization
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Legal Business Name | POTOMAC MEDICAL SERVICES
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 10/17/2014
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Provider Practice Location Address
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Address Line | 41338 RASPBERRY DR
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City | LEESBURG
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State | VA
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Zip | 20176-7826
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Country | US
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Telephone | 703-669-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 41338 RASPBERRY DR
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City | LEESBURG
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State | VA
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Zip | 20176-7826
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRES
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Name | JOHN DWYER
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Credential |
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Telephone | 703-669-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 07808173
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License Number State | VA
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