Potomac Integrative Health PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

21679 Issued in WV

Legal business name

POTOMAC INTEGRATIVE HEALTH PLLC

Practice address

51 Maddex Square Drive
Shepherdstown, WV 25443-4310

Phone

(304) 876-2447

NPI assigned

Apr 1, 2013

Last updated

Apr 1, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David DiddenNPI 1659375905

Title

Sole Member

Phone

(304) 876-2447

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David Didden, M.D.

  • Family Medicine Physician
  • Shepherdstown, WV
  • NPI 1659375905
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1364774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364774400000",
    "number": "1639412398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1311",
            "address_2": "51 MADDEX SQUARE DRIVE",
            "city": "SHEPHERDSTOWN",
            "state": "WV",
            "postal_code": "254431311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 MADDEX SQUARE DRIVE",
            "city": "SHEPHERDSTOWN",
            "state": "WV",
            "postal_code": "254434310",
            "telephone_number": "304-876-2447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTOMAC INTEGRATIVE HEALTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-01",
        "last_updated": "2013-04-01",
        "status": "A",
        "authorized_official_last_name": "DIDDEN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "304-876-2447"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "WV",
            "license": "21679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J. Peterson, PH.D., L.L.C.
• Polonchak Educational Associates
• Cathy Polonchak, LICSW
• Potomac Crossroads Counseling, LLC
• Potomac Integrative Health PLLC
• Pratima Chandler DDS PLLC
• Professional Sportscare & Rehab of West Virginia, LLC
• Professional Sportscare & Rehab of West Virginia, LLC (Pivot Physical Therapy)
• Providence Counseling Ministries, Inc (New Horizons Counseling Services)
• Pure Performance Sportscare and Rehabilitation

• Primary Care Clinic/Center in Shepherdstown, WV
• Providers in Shepherdstown, WV by specialty
• Primary Care Clinic/Center in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.