Organization
POTOMAC FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBORAH R LEE (PRACTICE MANAGER)
(301) 791-7900
Entity
Organization
Contact information
Practice address
13424 PENNSYLVANIA AVE, SUITE 101, HAGERSTOWN, MD 21742
(301) 791-7900
(301) 791-3686
Mailing address
1324 PENNSYLVANIA AVE, SUITE 101, HAGERSTOWN, MD 21742
(301) 791-7900
(301) 791-3686
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
NOT APPLICABLE
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202589
FEDERAL BLACK LUNG PROGRA
MD
05
—
599121800
—
MD
01
—
S328
BLUECROSS/BLUESHIELD
MD
Enumeration date
06/15/2005
Last updated
05/07/2008
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