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Organization
POTOMAC INOVA HEALTHCARE ALLIANCE
Active
Organization
POTOMAC INOVA HEALTHCARE ALLIANCE
Active
Other names
Potomac Radiation Oncology Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JACKIE MASON (DIRECTOR)
(703) 670-3349
Entity
Organization
Contact information
Practice address
2296 OPITZ BLVD, SUITE 140, WOODBRIDGE, VA 22191-3300
(703) 670-3349
(703) 580-0730
Mailing address
2990 TELESTAR CT, SUITE 3PI, FALLS CHURCH, VA 22042-1207
(571) 423-5727
(571) 423-5701
Taxonomy
Speciality
Code
Description
License number
State
261QX0203X
Radiation Oncology Clinic/Center
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007603118
—
VA
01
—
2108004
MAMSI
VA
01
—
245110
ANTHEM
VA
01
—
2521782
AETNA HMO
VA
01
—
7154230
AETNA PPO
VA
Enumeration date
04/15/2008
Last updated
02/26/2013
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