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General NPI Number Information
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NPI Number | 1780866178
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Entity Type | Organization
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Legal Business Name | POTOMAC PODIATRY ASSOCIATES LTD
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 05/17/2013
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Provider Practice Location Address
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Address Line | 15700 CHAPMAN PL
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City | MONTCLAIR
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State | VA
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Zip | 22025-1315
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Country | US
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Telephone | 703-370-5533
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Fax | 703-680-9579
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Provider Business Mailing Address
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Address Line | 15700 CHAPMAN PL
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City | MONTCLAIR
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State | VA
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Zip | 22025-1315
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Country | US
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Telephone | 703-370-5533
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Fax | 703-680-9579
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. JEROME LOUIS DOVBERG
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Credential | DPM
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Telephone | 703-370-5533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0103000339
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License Number State | VA
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