Provider Demographics
NPI:1003010489
Name:POTOMAC AUDIOLOGY LLC
Entity Type:Organization
Organization Name:POTOMAC AUDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:VINZE
Authorized Official - Middle Name:B
Authorized Official - Last Name:TERLEP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-477-1010
Mailing Address - Street 1:11300 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3003
Mailing Address - Country:US
Mailing Address - Phone:240-477-1010
Mailing Address - Fax:240-477-1014
Practice Address - Street 1:11300 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 105
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3003
Practice Address - Country:US
Practice Address - Phone:240-477-1010
Practice Address - Fax:240-477-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD875231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty