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General NPI Number Information
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NPI Number | 1932310703
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Entity Type | Organization
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Legal Business Name | POTOMAC RIVER CLINIC
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 4880 MACARTHUR BLVD NW
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City | WASHINGTON
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State | DC
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Zip | 20007-1557
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Country | US
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Telephone | 202-333-1403
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Fax | 202-333-1404
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Provider Business Mailing Address
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Address Line | 4880 MACARTHUR BLVD NW
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City | WASHINGTON
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State | DC
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Zip | 20007-1557
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Country | US
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Telephone | 202-333-1403
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Fax | 202-333-1404
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Authorized Official
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Title or Position | ASSISTANT DIRECTOR
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Name | MEREDITH OUELLETTE
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Credential |
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Telephone | 202-333-1403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 2201001368
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License Number State | VA
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