Provider Demographics
NPI:1023262656
Name:POTOMAC PULMONARY, INC.
Entity type:Organization
Organization Name:POTOMAC PULMONARY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:MANOCHEHR
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBHANY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-491-4134
Mailing Address - Street 1:13001 SUMMIT SCHOOL RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2903
Mailing Address - Country:US
Mailing Address - Phone:703-491-4134
Mailing Address - Fax:703-491-1813
Practice Address - Street 1:13001 SUMMIT SCHOOL RD
Practice Address - Street 2:SUITE 4
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2903
Practice Address - Country:US
Practice Address - Phone:703-491-4134
Practice Address - Fax:703-491-1813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101021024207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006061575Medicaid
VA006061575Medicaid