Provider Demographics
NPI:1790176170
Name:POTOMAC VIEW ANESTHESIA, LLC
Entity Type:Organization
Organization Name:POTOMAC VIEW ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:IZADI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:301-829-7683
Mailing Address - Street 1:1302 RISING RIDGE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-5790
Mailing Address - Country:US
Mailing Address - Phone:301-829-7683
Mailing Address - Fax:301-829-7694
Practice Address - Street 1:6710 OXON HILL RD
Practice Address - Street 2:SUITE 150
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1117
Practice Address - Country:US
Practice Address - Phone:301-829-7683
Practice Address - Fax:301-829-7694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty