Provider Demographics
NPI:1932178902
Name:POTOMAC VALLEY SLEEP CENTER, LLC
Entity Type:Organization
Organization Name:POTOMAC VALLEY SLEEP CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-697-3839
Mailing Address - Street 1:507 N CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2102
Mailing Address - Country:US
Mailing Address - Phone:301-724-7378
Mailing Address - Fax:301-722-4787
Practice Address - Street 1:507 N CENTRE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2102
Practice Address - Country:US
Practice Address - Phone:301-724-7378
Practice Address - Fax:301-722-4787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01988075261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD238CPOOtherBLUE CROSS BLUE SHIELD
FMS006Medicare ID - Type Unspecified