Provider Demographics
NPI:1184749327
Name:POTOMAC PEDIATRIC CARE
Entity type:Organization
Organization Name:POTOMAC PEDIATRIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBBIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-840-0840
Mailing Address - Street 1:18506 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-0585
Mailing Address - Country:US
Mailing Address - Phone:301-840-0840
Mailing Address - Fax:
Practice Address - Street 1:18506 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-0585
Practice Address - Country:US
Practice Address - Phone:301-840-0840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty