Organization
POTOMAC INOVA HEALTHCARE ALLIANCE, LLC
Active
Other names
Woodbridge CT
Organization subpart
No
Provider details
NPI number
Authorized official
COLLEEN HUELSKAMP (PROJECT MANAGER)
(703) 204-6371
Entity
Organization
Contact information
Practice address
4001 PRINCE WILLIAM PKWY, WOODBRIDGE, VA 22192-7630
(703) 494-3309
(703) 357-9636
Mailing address
2990 TELESTAR CT, SUITE 3PI, FALLS CHURCH, VA 22042-1207
(571) 423-5727
(571) 423-5702
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
344745
ANTHEM
VA
Enumeration date
04/15/2008
Last updated
11/23/2010
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