Provider Demographics
NPI:1245348549
Name:POTOMAC VALLEY ORTHOPEDIC ASSOC, CHARTERED
Entity type:Organization
Organization Name:POTOMAC VALLEY ORTHOPEDIC ASSOC, CHARTERED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-774-0500
Mailing Address - Street 1:PO BOX 960
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20830-0960
Mailing Address - Country:US
Mailing Address - Phone:301-774-0501
Mailing Address - Fax:301-774-1186
Practice Address - Street 1:3414 OLANDWOOD CT
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1384
Practice Address - Country:US
Practice Address - Phone:301-774-0501
Practice Address - Fax:301-774-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019012208100000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0827610004Medicare NSC
DC410053Medicare PIN
MD376MMedicare PIN
MD0827610001Medicare NSC
MD0827610002Medicare NSC
MD579LMedicare PIN
MD0827610003Medicare NSC
DC709956Medicare PIN