Provider Demographics
NPI:1437239944
Name:POTOMAC MEDICAL CENTER PC
Entity Type:Organization
Organization Name:POTOMAC MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:TU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-237-2488
Mailing Address - Street 1:6404 SEVEN CORNERS PL STE G
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2034
Mailing Address - Country:US
Mailing Address - Phone:703-237-2488
Mailing Address - Fax:703-237-2492
Practice Address - Street 1:6404 SEVEN CORNERS PL STE G
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2034
Practice Address - Country:US
Practice Address - Phone:703-237-2488
Practice Address - Fax:703-237-2492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045181207K00000X
VA0101045328207R00000X
VI0101045181208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PO767887Medicare ID - Type Unspecified