Provider Demographics
NPI:1003051897
Name:POTOMAC PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:POTOMAC PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TOUCHETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-730-5437
Mailing Address - Street 1:2296 OPITZ BLVD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3300
Mailing Address - Country:US
Mailing Address - Phone:703-730-5437
Mailing Address - Fax:703-730-5443
Practice Address - Street 1:2296 OPITZ BLVD
Practice Address - Street 2:SUITE 510
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3300
Practice Address - Country:US
Practice Address - Phone:703-730-5437
Practice Address - Fax:703-730-5443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA07L06196261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care