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General NPI Number Information
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NPI Number | 1528521705
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Entity Type | Organization
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Legal Business Name | OSTEOPATHIC PHYSICIANS OF THE POTOMAC
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Dates
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Enumeration Date | 04/13/2019
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Last Update Date | 04/13/2019
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Provider Practice Location Address
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Address Line | 10810 DARNESTOWN RD STE 205
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City | GAITHERSBURG
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State | MD
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Zip | 20878-2601
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Country | US
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Telephone | 301-660-8855
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Fax |
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Provider Business Mailing Address
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Address Line | 9300 CORPORATE BLVD APT 1347
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City | ROCKVILLE
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State | MD
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Zip | 20850-3795
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Country | US
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Telephone | 601-466-4351
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GRADY KAISER
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Credential | DO
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Telephone | 301-660-8855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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