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General NPI Number Information
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NPI Number | 1689397739
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Entity Type | Organization
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Legal Business Name | POTOMAC INSTITUTE OF PAIN MANAGEMENT AND PALLIATIVE CARE SERVICES
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Dates
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Enumeration Date | 09/23/2022
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 8435 PROGRESS DR STE EE
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City | FREDERICK
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State | MD
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Zip | 21701-4981
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Country | US
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Telephone | 301-624-5390
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Fax |
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Provider Business Mailing Address
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Address Line | 8435 PROGRESS DR STE EE
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City | FREDERICK
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State | MD
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Zip | 21701-4981
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Country | US
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Telephone | 301-624-5390
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE
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Name | GLORIA CORBIN
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Credential |
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Telephone | 301-732-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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