Provider Demographics
NPI:1801186622
Name:POTOMAC VALLEY PEDIATRICS
Entity Type:Organization
Organization Name:POTOMAC VALLEY PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AVNEET
Authorized Official - Middle Name:K
Authorized Official - Last Name:BAWA
Authorized Official - Suffix:
Authorized Official - Credentials:M,D
Authorized Official - Phone:301-990-6333
Mailing Address - Street 1:11908 DARNESTOWN RD
Mailing Address - Street 2:SUTE G & H
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2295
Mailing Address - Country:US
Mailing Address - Phone:301-990-6333
Mailing Address - Fax:301-519-0474
Practice Address - Street 1:11908 DARNESTOWN RD
Practice Address - Street 2:SUTE G & H
Practice Address - City:NORTH POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20878-2295
Practice Address - Country:US
Practice Address - Phone:301-990-6333
Practice Address - Fax:301-519-0474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty