Organization
POTOMAC VILLAGE FAMILY PRACTICE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHLEEN MARIE CHANDLER (OFFICE MANAGER)
(703) 494-1028
Entity
Organization
Contact information
Practice address
2010 OPITZ BLVD STE A, WOODBRIDGE, VA 22191-3359
(703) 494-1028
(703) 494-0445
Mailing address
2010 OPITZ BLVD STE A, WOODBRIDGE, VA 22191-3359
(703) 494-1028
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
07L15218
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036099
ANTHEM BLUE CROSS
VI
05
—
5676410
—
VA
Enumeration date
05/15/2007
Last updated
09/20/2007
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