Provider Demographics
NPI:1215685896
Name:POTOMAC DERMATOLOGY AND SKINCARE CENTER
Entity type:Organization
Organization Name:POTOMAC DERMATOLOGY AND SKINCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LILY
Authorized Official - Middle Name:
Authorized Official - Last Name:TALAKOUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-626-3648
Mailing Address - Street 1:6849 OLD DOMINION DR STE 450
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3718
Mailing Address - Country:US
Mailing Address - Phone:703-626-3648
Mailing Address - Fax:
Practice Address - Street 1:9812 FALLS RD STE 124
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3976
Practice Address - Country:US
Practice Address - Phone:703-356-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty