# POTOMAC SPINE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083158885
- **Authorized official:** KAL KAHLOON (CEO)
- **Authorized official phone:** (240) 629-3990

## Contact information

- **Practice address:** 1050 KEY PKWY STE 103, FREDERICK, MD 21702-4496
- **Practice address phone:** (240) 629-3982
- **Mailing address:** 1050 KEY PKWY, SUITE 202, FREDERICK, MD 21702-4053
- **Mailing address phone:** (240) 629-3990

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 207XS0117X | Orthopaedic Surgery of the Spine Physician | — | NULL | — |
| 207XS0117X | Orthopaedic Surgery of the Spine Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 208VP0014X | Interventional Pain Medicine Physician | — | NULL | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 12/13/2016
- **Last updated:** 03/17/2018