Organization
POTOMAC HOSPITAL CORPORATION OF PRINCE WILLIAM
Active
Parent organization
SENTARA HEALTHCARE
Other names
Lake Ridge
Organization subpart
Yes
Provider details
NPI number
Legal business name
SENTARA HEALTHCARE
Authorized official
MR. ROBERT A BROERMANN (SVP/CFO)
(757) 455-7020
Entity
Organization
Contact information
Practice address
12825 MINNIEVILLE ROAD, LAKE RIDGE, VA 22192-9998
(703) 523-9800
Mailing address
12825 MINNIEVILLE ROAD, LAKE RIDGE, VA 22192-9998
(703) 523-9800
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
VA
Other
Enumeration date
03/26/2012
Last updated
03/26/2012
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