Provider Demographics
NPI:1750310033
Name:WASHINGTON POTENCY & UROLOGY
Entity Type:Organization
Organization Name:WASHINGTON POTENCY & UROLOGY
Other - Org Name:WASHINGTON SURGI CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OTHMAN
Authorized Official - Middle Name:AHMAD
Authorized Official - Last Name:BABAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-839-0770
Mailing Address - Street 1:6228 OXON HILL RD
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745
Mailing Address - Country:US
Mailing Address - Phone:301-839-0770
Mailing Address - Fax:301-839-1350
Practice Address - Street 1:6228 OXON HILL RD
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745
Practice Address - Country:US
Practice Address - Phone:301-839-0770
Practice Address - Fax:301-839-1350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1049208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDSXOtherCAREFIRST MD
MDSXOtherCAREFIRST
DCNKIOtherCAREFIRST DC
MD218613OtherMAMSI HEALTH
MD307150Medicare PIN
MD218613OtherMAMSI HEALTH
MDSXOtherCAREFIRST