Provider Demographics
NPI:1689397739
Name:POTOMAC INSTITUTE OF PAIN MANAGEMENT AND PALLIATIVE CARE SERVICES
Entity Type:Organization
Organization Name:POTOMAC INSTITUTE OF PAIN MANAGEMENT AND PALLIATIVE CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-732-6300
Mailing Address - Street 1:8435 PROGRESS DR STE EE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4981
Mailing Address - Country:US
Mailing Address - Phone:301-624-5390
Mailing Address - Fax:
Practice Address - Street 1:8435 PROGRESS DR STE EE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4981
Practice Address - Country:US
Practice Address - Phone:301-624-5390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain