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General NPI Number Information
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NPI Number | 1881661379
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Entity Type | Organization
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Legal Business Name | POTOMAC AMBULATORY SURGERY CENTER
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Dates
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Enumeration Date | 03/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8503 ARLINGTON BOULEVARD SUITE 150
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City | FAIRFAX
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State | VA
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Zip | 22031-4603
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Country | US
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Telephone | 703-204-0000
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Fax | 301-564-6391
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Provider Business Mailing Address
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Address Line | 6410 ROCKLEDGE DR SUITE 300
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City | BETHESDA
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State | MD
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Zip | 20817-7811
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Country | US
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Telephone | 301-564-3131
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Fax | 301-564-6391
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Authorized Official
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Title or Position | PARTNER / PHYSICIAN
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Name | MARK LAWRENCE WELCH
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Credential | M.D.
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Telephone | 301-564-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | OH 692
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License Number State | VA
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