Potomac Village Family Practice PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

07L15218 Issued in VA

Legal business name

POTOMAC VILLAGE FAMILY PRACTICE PC

Practice address

2010 Opitz Blvd Ste a
Woodbridge, VA 22191-3359

Phone

(703) 494-1028

Fax

(703) 494-0445

NPI assigned

May 15, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Kathleen Marie Chandler

Title

Office Manager

Phone

(703) 494-1028

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190246400000",
    "number": "1982810016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2010 OPITZ BLVD STE A",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221913359",
            "telephone_number": "703-494-1028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2010 OPITZ BLVD STE A",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221913359",
            "telephone_number": "703-494-1028",
            "fax_number": "703-494-0445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTOMAC VILLAGE FAMILY PRACTICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2007-09-20",
        "status": "A",
        "authorized_official_last_name": "CHANDLER",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "703-494-1028",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "07L15218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5676410",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "036099",
            "state": "VI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Potomac Pediatrics, P.C.
• Potomac Podiatry PLLC
• Potomac Pulmonary, Inc.
• Potomac Radiology & Imaging Associates Inc
• Potomac Shores Mental Health & Wellness LLC
• Jenny Lee Potter, APRN
• Clayton G Powell, PMHNP-BC
• Powerback Rehabilitation LLC (Powerback Rehabilitation)
• Powers Distribution LLC (Powers Transportation)
• Prachak T Siriprakorn M.D. P.C.

• Family Medicine Physician in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2007; 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.