Provider Demographics
NPI:1578601795
Name:POTOMAC FAMILY ALLERGY AND ASTHMA, LLC
Entity Type:Organization
Organization Name:POTOMAC FAMILY ALLERGY AND ASTHMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:ISENBERG-FEIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-770-7007
Mailing Address - Street 1:PO BOX 60247
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20859-0247
Mailing Address - Country:US
Mailing Address - Phone:301-770-7007
Mailing Address - Fax:301-770-7107
Practice Address - Street 1:11119 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 502
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3143
Practice Address - Country:US
Practice Address - Phone:301-770-7007
Practice Address - Fax:301-770-7107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056547207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI09706Medicare UPIN
MDG01975P01Medicare ID - Type Unspecified