Provider Demographics
NPI:1245242528
Name:POTOMAC NEPHROLOGY, INC.
Entity Type:Organization
Organization Name:POTOMAC NEPHROLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-528-3580
Mailing Address - Street 1:1 EXECUTIVE PARK CT
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2643
Mailing Address - Country:US
Mailing Address - Phone:301-528-3580
Mailing Address - Fax:301-528-3589
Practice Address - Street 1:1 EXECUTIVE PARK CT
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2643
Practice Address - Country:US
Practice Address - Phone:301-528-3580
Practice Address - Fax:301-528-3589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD40201207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF-48564Medicare UPIN
MDG-01687Medicare ID - Type Unspecified