Provider Demographics
NPI:1528521705
Name:OSTEOPATHIC PHYSICIANS OF THE POTOMAC
Entity type:Organization
Organization Name:OSTEOPATHIC PHYSICIANS OF THE POTOMAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRADY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:301-660-8855
Mailing Address - Street 1:9300 CORPORATE BLVD APT 1347
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3795
Mailing Address - Country:US
Mailing Address - Phone:601-466-4351
Mailing Address - Fax:
Practice Address - Street 1:10810 DARNESTOWN RD STE 205
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-2601
Practice Address - Country:US
Practice Address - Phone:301-660-8855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-13
Last Update Date:2019-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center