| Organization Name: | POTOMAC INOVA HEALTHCARE ALLIANCE |
| NPI Number: | 1013181791 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JACKIE MASON (DIRECTOR) |
| Mailing Address: | 2296 Opitz Blvd Suite 140 Woodbridge |
| State: | VA US |
| Postal Code: | 221913300 |
| Phone Number: | 7036703349 |
| Fax Number: | 7035800730 |
| NPI Enumeration Date: | 04/15/2008 |
| NPI Last Update Date: | 02/26/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QX0203X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Oncology, Radiation |
| Taxonomy Definition: | |