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1487794673 NPI number — POTOMAC MEDICAL LLC

NPI Number: 1487794673
Health Care Provider/Practitioner: POTOMAC MEDICAL LLC

Information about “1487794673” NPI (POTOMAC MEDICAL LLC) exists in 1487794673 in HTML format HTML  |  1487794673 in plain Text format TXT  |  1487794673 in PDF (Portable Document Format) PDF  |  1487794673 in an XML format XML  formats.

NPI Number : 1487794673 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1487794673",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "POTOMAC MEDICAL LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "420 E PATRICK ST",
    "SecondLineMailingAddress": "SUITE 200",
    "MailingAddressCityName": "FREDERICK",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21701-5658",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "301-682-7800",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "420 E PATRICK ST",
    "SecondLinePracticeLocationAddress": "SUITE 200",
    "PracticeLocationAddressCityName": "FREDERICK",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21701-5658",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "301-682-7800",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/07/2007",
    "LastUpdateDate": "08/22/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BURKHOLDER",
    "AuthorizedOfficialFirstName": "ERIC",
    "AuthorizedOfficialMiddleName": "JAMES",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "301-698-7420",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "332900000X",
        "TaxonomyName": "Non-Pharmacy Dispensing Site",
        "LicenseNumber": "D01537",
        "LicenseNumberStateCode": "MD",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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