| Potomac Village Family Practice Pc | |
|
2010 Opitz Blvd Ste A Woodbridge VA 22191-3359 | |
| (703) 494-1028 | |
| (703) 494-0445 |
| Full Name | Potomac Village Family Practice Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 2010 Opitz Blvd Ste A, Woodbridge, Virginia |
| Authorized Official Name and Position | Kathleen Marie Chandler (OFFICE MANAGER) |
| Authorized Official Contact | 7034941028 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Potomac Village Family Practice Pc 2010 Opitz Blvd Ste A Woodbridge VA 22191-3359 Ph: (703) 494-1028 | Potomac Village Family Practice Pc 2010 Opitz Blvd Ste A Woodbridge VA 22191-3359 Ph: (703) 494-1028 |
| NPI Number | 1982810016 |
|---|---|
| Provider Enumeration Date | 05/15/2007 |
| Last Update Date | 09/20/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982810016 | NPI | - | NPPES |
| 5676410 | Medicaid | VA | |
| 036099 | Other | VI | ANTHEM BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 07L15218 (Virginia) | Primary |
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