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
—
—
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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