Provider Demographics
NPI:1710586300
Name:POTOMAC AUDIOLOGY LLC
Entity Type:Organization
Organization Name:POTOMAC AUDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALIDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ARABSHAHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-481-2442
Mailing Address - Street 1:14000 CROWN CT STE 201
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-1463
Mailing Address - Country:US
Mailing Address - Phone:571-481-2442
Mailing Address - Fax:703-619-5283
Practice Address - Street 1:14000 CROWN CT STE 201
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1463
Practice Address - Country:US
Practice Address - Phone:571-481-2442
Practice Address - Fax:703-619-5283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty