Provider Demographics
NPI:1922647775
Name:POTOMAC ON CALL LLC
Entity Type:Organization
Organization Name:POTOMAC ON CALL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-836-1436
Mailing Address - Street 1:11100 POWDER HORN DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2539
Mailing Address - Country:US
Mailing Address - Phone:202-604-1405
Mailing Address - Fax:
Practice Address - Street 1:11215 SEVEN LOCKS RD
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3260
Practice Address - Country:US
Practice Address - Phone:301-836-1436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty