Provider Demographics
NPI:1518983139
Name:SOUTH POTOMAC BONE ASSESSMENT CENTER
Entity Type:Organization
Organization Name:SOUTH POTOMAC BONE ASSESSMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGER
Authorized Official - Middle Name:VERDAN
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-574-0540
Mailing Address - Street 1:1328 SOUTHERN AVE SE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4689
Mailing Address - Country:US
Mailing Address - Phone:202-574-0540
Mailing Address - Fax:202-562-6140
Practice Address - Street 1:1328 SOUTHERN AVE SE
Practice Address - Street 2:SUITE 210
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4689
Practice Address - Country:US
Practice Address - Phone:202-574-0540
Practice Address - Fax:202-562-6140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology