Organization
POTOMAC RIVER CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEREDITH OUELLETTE (ASSISTANT DIRECTOR)
(202) 333-1403
Entity
Organization
Contact information
Practice address
4880 MACARTHUR BLVD NW, WASHINGTON, DC 20007-1557
(202) 333-1403
(202) 333-1404
Mailing address
4880 MACARTHUR BLVD NW, WASHINGTON, DC 20007-1557
(202) 333-1403
(202) 333-1404
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
2201001368
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1231037
AETNA HMO ID# MCLEAN
VA
01
—
2532733
AETNA HMO ID RICHMOND
VA
01
—
353800
ANTHEM BC/BS
VA
01
—
5500795
AETNA ID PPO
VA
01
—
69161
OPTIMA HEALTH
VA
Enumeration date
05/24/2007
Last updated
10/05/2021
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