1205385952 NPI number — POTOMAC FAMILY PLANNING CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205385952 NPI number — POTOMAC FAMILY PLANNING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POTOMAC FAMILY PLANNING CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205385952
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
966 HUNGERFORD DR
Provider Second Line Business Mailing Address:
SUITE 24
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20850-1714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-251-9124
Provider Business Mailing Address Fax Number:
301-251-8581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
966 HUNGERFORD DR
Provider Second Line Business Practice Location Address:
SUITE 24
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-1714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-251-9124
Provider Business Practice Location Address Fax Number:
301-251-8581
Provider Enumeration Date:
09/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MCLEOD
Authorized Official First Name:
EARL
Authorized Official Middle Name:
NATHANIEL
Authorized Official Title or Position:
OWNER/MEDICAL DIRECTOR
Authorized Official Telephone Number:
301-251-9124

Provider Taxonomy Codes

  • Taxonomy code: 261QA0005X , with the licence number:  SA000011 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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