Provider Demographics
NPI:1558602854
Name:POTOMAC NEUROLOGY, LLP
Entity type:Organization
Organization Name:POTOMAC NEUROLOGY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:240-477-5973
Mailing Address - Street 1:9707 MEDICAL CENTER DR STE 220
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6338
Mailing Address - Country:US
Mailing Address - Phone:240-477-5973
Mailing Address - Fax:301-519-0279
Practice Address - Street 1:9707 MEDICAL CENTER DR STE 220
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6338
Practice Address - Country:US
Practice Address - Phone:240-477-5973
Practice Address - Fax:301-519-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00622402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty